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4 <br /> LAND USE PERMIT APPLICATION— Burnett County, WI C r <br /> a g <br /> Applicant Complete All Sections Below This Line 0 ' w <br /> c. <br /> Permit Types and Fees:(Please,check appropriate boxes) C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ( <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 /> ri <br /> Filling/Grading $150 Boathouse $500 az II <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 to three 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. - r <br /> % <br /> z <br /> Property Owner's Name: ( t Riz y J itv 1=N S v A-' . ---1- i" -n o <br /> 0 <br /> �� <br /> a. 0 <br /> Property Owner's Mailing Address: I.t'_3� NepILTi+-c t2 D�. G 'K �ei1 �I' n <br /> City ,State Zip I <br /> Property Site Address: (IS-5/ Ale.Slte Q2y G aird3Rc/Z� l 5044 o v <br /> 7 • <br /> Contact's Telephone Number: Z-- g ,/�g' `-'d 3 <br /> _ a `y o <br /> Contact's Email: / �4,L-NS6/U 3g0qt/1414-, C D- 4? <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is 1 N b <br /> legible and your email provider will accept emails from the following addresses:�a),BurnettCounty.org and d <br /> 5' <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: Se?..-C.. 27, (N 3 Y, R (0 PC.L.. (,OV L''T 6, 5_• <br /> Section#: 2.7 Town#: 3 g N Range#: (ei W Town of: WOOD R i v E2 `/, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o i <br /> Tax ID#(1-5 digit number;found on tax statement): 2 q0 l <br /> z-/kly ee`v� .}i f-!(3t 0�'a <br /> Proposed Use of Structure/A ition RC PLC-c/1 C5 RR e) O/ & 2 44C3t- G —d <br /> 13 <br /> Anticipated Start Date: 9/Z 3/2..3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) l'..'Building Contractor: OG"Nt/2 /0 Oe !ti'0 CI( Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY K. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED <br /> 1BELOW: <br /> C ,n�•3 47%45 I ci a s0VJ (eel (crt P1 J a t chvrq 1 <br /> C 44 4 Q nOP1 i f-o r,410' k-ch.v- <br /> I Jc L i /hrt. <br /> ,ht, 4 J br � chtl kk �� <br /> z Fee Rec�l'�� ,J <br /> v ' Check#: 13j 3q1 <br /> M <br /> Date of staff site visit:I ` i?3 Initials site visi staff: i°i < r(' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: l i/5N 3 luul _ , E <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF = <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m C <br /> Page 1 of 5 .. m °' <br /> Rnrnntt('nuntm WI 1 and iTea A nn,liootinn-Ras, 2/11111 MI)'- <br /> Co <br /> J <br /> I 1 <br />