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LAND USE PERMIT APPLICATION —Burnett County, WI a ..I_ <br /> • Applicant Complete All Sections Below This Line 0' w <br /> Permit Types and Fees(Please,check appropriate boxes) ° <br /> G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 A . cp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 N O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 " � G� <br /> g <br /> iDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ! <br /> V Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 O pal <br /> Filling/Grading $150 Boathouse $500 v'' <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. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: e.. v` e., Or 'Ti (1 <br /> io <br /> a. <br /> Property Owner's Mailing Address: /3(Q s 1.0h L..6fl r ! . g qi . (�C.b&614-ry <br /> / � n <br /> p/ rCt./1 �"f" <br /> ( ! 5 C � ��-/'�G City �/ to Zip SS�� <br /> Property Site Address: 2G o y ,I <br /> Contact's Telephone Number: (p 5 l- 7, 3 ?- ”"--Q a. ' <br /> r7 <br /> Contact's Email: f Q 1' y 5/L, �i ✓YIGC_f / . (o w) CD**If staff has a question about thi application,'yoj will be contacted via email. Make sure your email address is N <br /> tro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o <br /> @BurnettCountyWl.gov <br /> Legal Description of Property:'V, 1 11-1 t 'Akre/4 /� , . jp�'✓ 5 <br /> (j . <br /> Section#:3.j Town#: 4 r N Range#: ! W Town of: SAIL SS A v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 1 o <br /> Tax ID#(1-5 digit number; found on tax statement): 2a5 <br /> ! `� t7 <br /> Proposed Use of Structure/Addition: 114.1141 -1D 'fr <br /> Anticipated Start Date: c (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) e <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMITI IS(SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 4p Meet c 6I 5el' c O 1 fk be <br /> �ckr in - t'e�d <br /> etto, walk Ay. <br /> 6 OpI-(c J-,, / 4eL (es-Iz kO/1 <br /> /I <br /> G( a 7.....iteme.6 <br /> co/ rCMo✓a _c� re(� �„ . L.,„0 {t�.ghi. x Fee Rec6 I � <br /> 0 ��✓ <br /> 05hed wail;i 70 se4-1),,,4 7v b� �/NrO/ e' i t' /��3 O� o Check#:Ccx S�c <br /> ) <br /> Cc (Aln c be :55u ee .rr <br /> Date of staff site visit: 0'i5/Zoi3 t'al of site visi taft I y �J'n�.,, <br /> < w inn] <br /> n n <br /> APPROVED BY LAND SERVICES OFFICIAL: // DATE / 2-3 y <br /> CA CDs cw. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o y N <br /> IvU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 rrl CD <br /> < Inns <br /> Burnett County, WI Land Use Application—Rev 3/2023 v J <br /> cn <br /> 3 <br /> m <br />