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LAND USE PERMIT APPLICATION - Burnett County, WI i <br /> a. <br /> Applicant Complete All Sections Below This Line 0" cw <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Z.D, 00 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ 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 eta <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 }U O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 V <br /> Filling/Grading $150 Boathouse $500 <br /> c <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 /> z 11 <br /> p r <br /> Property Owner's Name: b,, La S A De tZ: An k Uv UK, o _. <br /> 0 <br /> 0. ! ;Y <br /> Property Owner's Mailing Address: Xri t 1 5'c v -- �E- . _.1) ('`)6 V"� 54 etg <br /> Es r of /� City Stag Zip = II�) <br /> Property Site Address: dr1 L t\(, 5 to*'E 5'°* ' ($ AdCSS i .S.S*p D •E-C \ C <br /> / o in <br /> • <br /> Contact's Telephone Number: S l ties k '{3 7 a v <br /> t�J a <br /> Contact's Email: _ i;,,,nlxMa, C g'M.A(r7(0 -I . ,�� ;� <br /> **If staff has a quAfion about this application,you will be contacted via email. Make sure your email address is .A <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °Q <br /> @BurnettCountyWLgov N <br /> b d <br /> Legal Description of Property: 1:.P-c ±" CSt44- V 3 4' ' i (Tr C-c . (-t ' a) -I <br /> Section#: 33 Town#: 4.13313Lt4N Range#: I � W Town of: O V1 4-'1) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* , <br /> Tax ID#(1-5 digit number; found on tax statement): C 3 ' ( 1 w d <br /> H_ <br /> Proposed Use of Structure/Addition: 'l�or—& ,---0(1s1 <br /> Anticipated Start Date: '' " SC"p'T .1_ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> -.D <br /> Building Contractor: 're•EA-DS4,P I.ES Sewer Installer: Ifogki:05` ! <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • IUkke,-. all s.0-ccta- <br /> •Dw-e lk inc) yt-t- -4-0 ,.X.(x uct 3 19circt (2e_' SrK-23- l 79 <br /> x Fee Rec: 1C° <br /> o Check#:<2 ,, <br /> m <br /> z <br /> v <br /> Date of staff site visit:7116 fzoz3 Ini 'als of site visit staff: T ¢ J <br /> APPROVED BY LAND SERVICES OFFICI DATE: 2 CA <br /> Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o CD 03 W `F r <br /> z m uu <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .CD CDa 0 <br /> Pagelof5 alCO <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 C <br /> a L.... J <br /> i <br />