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LAND USE PERMIT APPLICATION — Burnett County, WI `° <br /> b <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> . \ C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \p �, <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° `, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ! <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o • <br /> Z <br /> Property Owner's Name: A//eL `�_iizieG `11 oI. <br /> o <br /> o. <br /> Property Owner's Mailing Address: 3O 52 / ',,/CLC`fir-,Fa/ Ti'v ,iv/ e. p <br /> City ate Zip kp <br /> Property Site Address:335Z/ i,J e t/i.ed/ Dt-,✓Bd7/4,4.1i5 ,5"5/ 3d y <br /> Contact's Telephone Number: 743-W2-07Z0 .1 _ a <br /> d <br /> Contact's Email: $LP/7/// 6M/ . CGS `% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and CI° <br /> @BurnettCountyWl.gov <br /> q �1 <br /> Legal Description of Property: /?Z/1 (155t l . -7 97 1///7. .5 3. OS) <br /> Section#:,-q Town#: 49 N Range#: /5-r. W Town of: si,j/55 cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o63 <br /> Tax ID#(1-5 digit number;found on tax statement): 402J 55� <br /> Proposed Use of Structure/Addition: i01E <br /> Anticipated Start Date:AftiG Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Dc -672Zvo77v Pa - 67/24082.1 , Ci,,, <br /> Building Contractor: .2 /e•Lkre-S Sewer Installer: CO <br /> Z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 Mee cj Sep- �-S 44. 4 �e�,�or�s vi <br /> 00vVell, rio ��t� .9e 1 <br /> 3 ii j evu I -104 15ode ( il ! -llif:"1-. ell Fee Rec: clCgri� <br /> til <br /> itU ko� 1 o,/1 lS 01;A rr A.4id ( . d Check#:? 4 <br /> p p ,/ r <br /> 8 <br /> Date of staff site visit: ��/�� iti is sit vi ' staff: j-1 < r 1.. SAC <br /> / m APPROVED BY LAND SERVICES OFFICIAL: -( DATE: /I8J '� L_ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 5/2023 <br />