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LAND USE PERMIT APPLICATION - Burnett County, WI a § <br /> b <br /> Applicant Complete All Sections Below This Line 0 w <br /> a <br /> Permit Types and Feeselease,check appropriate boxes) � O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 01 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ‘ G p <br /> AAccessory Structure(Garage,Shed,etc.) $150 x Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r0 II <br /> Filling/Grading $150 Boathouse $500 v) <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> o. <br /> * After-the-factpermits(permit acquired after construction has begun)maycost uptothree times the normal fee. I 1 <br /> NOTE: q g ) lh <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 9 L <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o ' <br /> t�— f • <br /> Property Owner's Name: ?J .sZ F <br /> c nt -2-I'i =' Q 0 'v <br /> 0 IL <br /> o. <br /> Property Owner's Mailing Address: f,,,'Slj) 1-0_ t-k,c J2 n -.1<. 12' L. ,Y,}):,, JJJ, ., <136 7 n <br /> City State Zip c <br /> Property Site Address:L,S'.0 k \ a.r4k_o__,-, % <br /> 0 ,, <br /> CD <br /> Contact's Telephone Number: 1 Co5 r 3 07D"/-- of <br /> Contact's Email: D r2 7.A5 _r.0 eci Yr s. ,t . CAwL <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: @BurnettCounty.org and E <br /> 5 <br /> @BurnettCountyWI.gov °O <br /> d <br /> . r/ .1.4 <br /> Legal Description of Property: ; e--5 61 1 •,),q ',.,0 131 6. <br /> ..., <br /> Section#: ., Town#: '..{ C.-) N Range#: I(' W Town of: 0 j,-t j D -_ cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F <br /> Tax ID#(1-5 digit number; found on tax statement): 3"5 SI Cs, Ceiti � .1-'1_.-1 g 3 ‘)...) ° 6 <br /> Proposed Use of Structure/Addition: ) '..1.... <br /> it^(1- e , <br /> E. <br /> Anticipated Start Date: :0 - I - ..C) D-3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1, <br /> Building Contractor: `,� , ?r QCC L1'e Y Sewer Installer: FN (` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> t • <br /> THIS PERMIT IS SUBJECT TO ALL 0 I ITIONS LISTED BEL <br /> 9Thce4I1Seb4105+ r 11/tom <br /> r , s 3o Set ci <br /> eNoi- , Lew..1 Ik(4t,'- 0-71 <br /> okk, 1 a c'St .n pi r✓t i t- Sur Ce5 LL '' x Fee Rec: <br /> a/ i. A #4,-i-..0, co �a $ de a27 � °����-��/g o Check#: <br /> trl <br /> M, 1- tS ✓{mod (o O o U <br /> Date of staff site visit: KJ/�` Initiiall of s'te v' 't staff: t- < Qlin <br /> � ; f�/ 1f l�3 A C� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: CO°3 m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF zoo M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C' <br /> Page 1 of 5 al lin <br /> Burnett County,WI Land Use Application-Rev 3/2023 v �� JJ <br /> -3 <br /> a <br /> 3 <br /> b <br />