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cin <br /> LAND USE PERMIT APPLICATION — Burnett County, WI tn-- r <br /> g <br /> Applicant Complete All Sections Below This Line ° ca <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) o O T.' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .� O <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 /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk )C Bunkhouse $250 �. 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 �cn ' <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> w <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 2 % <br /> .o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `-° <br /> r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> z 0 <br /> Property Owner's Name: C 2 G 4%.<'k S on _ <br /> II <br /> Property Owner's Mailing Address: 3 e,c \ 01e-+La'S-4-'F°^^ R A 0 v``"'g• M N 5-75-$11 d <br /> n "4 City, State Zip c' <br /> Property Site Address: 244�3 Ce s'Q...r' Y a.�'S� Kl -4bs�-e...e- WI S.}e q 3 < - <br /> c n <br /> Contact's Telephone Number: -2.\a i �e — 3 Cp'3 1 c <br /> Contact's Email: C u,‹.- 1 S*0 v1 SO "Na.N k. Q 9("N c t ! • Co lh co <br /> **If staff has a question about this application, you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = w <br /> @BurnettCountyWl.gov ac ( <br /> Legal Description of Property: Pc L I NI G 0 V L 0T <br /> Section#: S O4 Town#:T38 4 N Range#: i<215W W Town of: Lc,t a 11 QA4-+. ,„ <br /> *Attach additional page i needed for lengthydescription OR attach a copyofthe deed OR attach tax system property page.** 0 -� <br /> P g f P Y P P b'P g P <br /> Tax ID#(1-5 digit number; found on tax statement): A 3 s i <br /> Proposed Use of Structure/Additio t O 4- 1.G, <br /> Anticipated Start Date: 1 75 23 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `� <br /> Building Contractor: ... R CIN <br /> - .-cw nc`� i,e a�4&� Sewer Installer: � J k <br /> AREA BELOW THIS'LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> -.);--- -..:1:)6 <br /> y � ULed es_ Fee Rec: <br /> •Cm�� ,r �"' ' rnpr2 ,J n 30 Qys t(NQ �.eU d Check#: COI O <br /> A bkc u gro.4 wa4e.-r yY\u 4- Ix_ coc'ktLi • > <br /> z <br /> Q a <br /> J 1 /Zol3 m J <br /> Date of staff site visit: Initials of site v' it staf : <rn �,n' <br /> r w <br /> / n fill <br /> APPROVED BY LAND SERVICES OFFICIA : ATE. I f 2o2� N CI. <br /> C- 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a a m <br /> Co o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w C <br /> Page 1of5 c 'ff <br /> Burnett County, WI Land Use Application - Rev 5/2023 u - ) J <br />