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LAND USE PERMIT APPLICATION — Burnett County, WI a 1 <br /> Applicant Complete All Sections Below This Line 0 c w <br /> a i <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :: 1 <br /> Commercial/Industrial Structure t $300 Addition/Alteration to Commercial/Industrial Structure $200 Si O <br /> x'Accessory Structure(Garage,Shed,etc.) J )16. Addition/Alteration to Accessory Structure $150 1 <br /> 1, 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 g ),) 0 <br /> Filling/Grading $150 Boathouse $500 API ` ' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. & -i <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. E "• i <br /> z 1 <br /> Property Owner's Name: ,,5 it ,.'lb a,f/f 1 �' • <br /> cfwln fin mil �1c <br /> • <br /> Property Owner's Mailing Address: a3 S 7 4/le J r J n <br /> `- City State '. t) <br /> Property Site Address: i ? 5-3- t-01)/ g4 Qi1 i3✓fy (4/.T '' i,30 o <br /> � ^ -� /(a <br /> Contact's Telephone Number:le s� �a qn0. <br /> � b <br /> Contact's Email: '4 h c. 46 c-/lc-1 C / ail Ind 4 COinCD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,9 <br /> o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and c 00 <br /> @BurnettCountyWI.gov [,� �� � <br /> Legal Description of Property: _ 0� oz ` a 'v 4. <br /> Section#: b/ Town#: 40 N Range#: 1 W Town of: 5(.04" 5 )7 ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* G f <br /> , 7 us, d <br /> Tax ID#(1-5 digit number;found on tax statement): 1 -)- ao <br /> ' w H <br /> Proposed Use of Structure/Addition: 5 f)N 4. PIfi 1tom. cst.6.'n 4 *oven 4 ce D <br /> Anticipated Start Date: (Home/Cabin;Commercial Bussi/iness,Bedroom!Deck;etc.) ,.�C '�er v <br /> Building Contractor: l�dcc I n Sewer Installer)O/Il e I <br /> II z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> V ✓i1ce r— 411 Se-6)4i=Ws <br /> W• do illdeci f1n b 1 1V"*ii II cc cony 14'44f spy r ,n is ; 1/ <br /> 6) ti�U' 1656k . 94 'bl�?( �VJ SkGve.)t1-e- y Fee Rec: T(.�) <br /> 1 ,-d71 o Check#: 7 <br /> h L__. <br /> J-IP <br /> Date of staff site visit: a/I(O1? 4(75/?3 Initials f site '•sit taff: ,, r LJ <br /> EN <br /> APPROVED BY LAND-SERVI�) S OFFICIAL:,ii DATE:�161a--1) cm <br /> -71 <br /> (CID)W m <br /> 03 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a <br /> z �_ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT x N Q <br /> Page 1 of 5 < (i(j] <br /> Burnett County, WI Land Use Application-Rev 12/2022 v - ` JJ <br /> a <br /> 3 <br />