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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ew <br /> Permit Types and Fees:(Please,check appropriate boxes) n.O IJ- <br /> ' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C.C) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 << <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o P <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 '1 i,' F <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. vv `'' <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. J <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> o i ' <br /> Property Owner's Name: 13;:- "T " (z EL, r 1 --aq,J o 'm. <br /> Property Owner's Mailing Address: '-'7) Z 9`c''j r-I 14 A/S c,tef 2---4-GC F.F. <br /> City State Zip ° E <br /> Property Site Address: �C,D 7-7- , �/(I/ o J 0 C y '` <br /> (y : o C <br /> Contact's Telephone Number: — Z �} b C� <br /> Contact's Email: '- a ('}"f S M 1J , C) AA <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °Q <br /> @BurnettCountyWl.gov o <br /> Legal Description of Property: (,o-T 11 S J 2 1Jq 3 cve Cp - Lip-! 3. j•1 <br /> Section#: Town#: N Range#: W Town of: . G d T <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ., c <br /> Tax ID#(1-5 digit number;found on tax statement): I 773Li 6 r7 <br /> .... ____ <br /> Proposed Use of Structure/Addition: ,:._, - :.�- . <br /> Anticipated Start Date: J CI (-' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O 0 ,.( <br /> Building Contractor: t--1 \ Sewer Installer: if,,i (� W <br /> Z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ifee- illse+ctk <br /> a 1\2*---Qc( 11,4it t ifici,L6,1h'co <br /> �i 0 <br /> Fee Rec: 51 <br /> o Check#: /0 1 <br /> rri <br /> z <br /> f cn o I J <br /> rn <br /> Date of staff site visit:0/2i 9-3 nitia s of ' e it staff: H � <br /> dPee- p� ^�/ LTrffl BY LAND SERVICES OFFICIAL DATE: H`/P"d(2 3 ' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o y a J ; <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m c. <br /> Page 1 of 5 m 3 c. linii <br /> Burnett County, WI Land Use Application—Rev 5/2023 0 �� J)E <br /> > <br /> K <br />