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. • LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> ILL.) <br /> Complete All Sections Below This Line a c o CD <br /> , <br /> Permit Types and Fees(Please,check appropriate boxes) CI. <br /> Dwelling/Principal Structure $300 ,Addition/Alteration to Dwelling/Principal Structure $200 cp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v,D <br /> XQ Accessory Structure(Garage,Shed,etc.) . $150 Addition/Alteration to Accessory Structure $150 g <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 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 tothree times the normal fee. `� <br /> ro <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. g' <br /> z <br /> o <br /> Property Owner's Name: PL►1 L 4. 41' V SG4n 0.1 k GX <br /> o 1110 <br /> Property Owner's Mailing��d• e s: 9�02_4( Gr er � f* J W SYW 5 n N^ <br /> N��dS - / 3 City State Zip ° `" <br /> Property Site Address: —'^ i kr6 55 4 P d"A 2"1"1 f9,S' C6tm., $LI 1.24 <br /> Contact's Telephone Number: (4 Z + 1.41. — (3 ` ( ° go <br /> C7 <br /> Contact's Email: tn1 IN}'it ►t". 3 t;Ut . Cv,.."- <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: B rnettCounty.org and °Q <br /> @BurnettCountyWl.gov 5,� .SW i , 6 a.c 4)cien i <br /> Legal Description of Property: 14 v 18d� '44- . 4)1►40 5 <br /> O g <br /> Section#: 2 0 Town#: l O N Range#: l 5 W Town of: 34,LAt p ,ti , <br /> *Attach additional page if needed for lengthy description OR attach <br /> a copy of the deed OR attach tax system property page.* <br /> yc/' f i:t.5 <br /> Tax ID#(1-5 digit number; found on tax statement): C,ac q °n <br /> Proposed Use of Structure/Addition: 6# 'A.S`Q- y <br /> Anticipated Start Date: 6{�`4 ' c2 Z.7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: 'vf <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ti <br /> mec} 41 $ th ks ,� UI <br /> ribsj5( ba.0, <br /> &]ddees5 .v be 41114t4( 46 b IV Il?-3 0� <br /> x Fee Rec: 1Zz <br /> v Check#: oZ 07 2 <br /> m <br /> z <br /> / lJ ci <br /> v <br /> Date of staff site visit: I/J�'` 3 itials•of si a vi ' staff: /'/✓ �- <br /> -, r— <br /> • // m w <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9/ ` /23 y a C H!F7 kl <br /> 3 � ED rf3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , o C <br /> Page l of 5 IA ' '- <br /> Burnett County, WI Land Use Application—Rev 3/2023 v , <br /> a <br /> �L )` <br /> 3 <br />