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LAND USE PERMIT APPLICATION—Burnett County, WI 1 a . e, <br /> Applicant Complete All Sections Below This Line o w <br /> Permk Types and Fees:(P/ease,check appropriate boxes) a` G <br /> a lc.n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 y <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> °C)T <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 t �, <br /> A <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 S' r <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 tothree times the normal fee. c <br /> Ili <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. Et 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. F. <br /> R� z <br /> Property Owner's Name: 1 v Jd 4-h c G,r�4. 4)►Z., P r i e 5 �i L-i— .51 <br /> _ o <br /> Property Owner's Mailing Address: e 0 be)( b 6 De,r` ,b to J. 5'/3O F % <br /> �i ►ra n <br /> City/ State Zip ° E <br /> �9 ) ( {-4&vc'ery I_c,K� f..� t- 0 0 _ <br /> Property Site Address: c y <br /> r <br /> Contact's Telephone Number: (4, 1 ). CZ 015) ?O 9 - )L 43 � G <br /> Contact's Email: \e I t e e (i M C+ (%0,..1-1-1 (-beer f 4 +( i'S • (G ry D C <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5 r <br /> @BurnettCountyWI.gov v 1 .2.).1 <br /> Legal Description of Property: 5 In)5 V1) S t:L5 f i; 6-5 S ,5'C/- b L. 'Pt� rC e I 'r D- -7 93) S. <br /> Section#: S Town#: 4-UlJ N Range#: Ho. W Town of: C)G. ►car.( v) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O, c <br /> Tax ID#(1-5 digit number;found on tax statement): 13 GC L c.11 <br /> CIS <br /> Proposed Use of Structure/Addition: 9e,K ) 5 I-. ed1 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) c <br /> Building Contractor: Sewer Installer: 1 •-� <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY • z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r_ <br /> 0 MeeA- 411 s4 <br /> OW- h04C0 ► ci <br /> p Fee Rec: 425 <br /> 179 <br /> VCg;�, ?D b2 11e547P to K. A 650,5. o Check#: 1r1(G <br /> m <br /> z <br /> trf <br /> Date of staff site visit:I?d� 03�' ti s of 't 'sit staff: alb/ <_ '��-rr- <br /> � � U` <br /> APPROVED BY LAND SERVICES OFFICIAL:_ ',, Q.G DATE: O/�f 2 3 m a 7> <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o -g NI <br /> z m ►+' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT A 6)C c <br /> Page 1 of 5 M B `a' ff <br /> Burnett County,WI Land Use Application-Rev 3/2023 y a <br /> 3 <br />