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r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a `° <br /> b <br /> Applicant Complete All Sections Below This Line °' CD w <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> y. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �j <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 . < ` - Q <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> E <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> -o <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 r <br /> v a <br /> Property Owner's Name: - C' t� o lk <br /> 1 <br /> i GC.Q b) <br /> Property Owner's Mailing Address: CA p\ �CY7 hell 5/ cP Z I. n t`' <br /> City State Zip E <br /> Property Site Address: &43 D--,,,t,,,,e\ 1 ?)04. &m (A) 5 �-o�- o <br /> CD <br /> Contact's Telephone Number: '15 —aX..j. rt-Ols .. <br /> Contact's Email: JO hn(Yt-ram ce eon <br /> **If staff has a question about this applicatio ,you contacted via email. Make sure your email address is N ,.d --1 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °0 <br /> @BurnettCountyWLgov aq W <br /> rr�� `� � o Iv <br /> Legal Description of Property: qOt .(� �UY 1( Yl I�C� , pt <br /> Section#: 1 a Town#: 3E3 N Range#: FA' W Town of: .Th,r1;E I S 1, N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N f <br /> _ o <br /> Tax ID#(1-5 digit number;found on tax statement): ,pj N,�-_1 <br /> .-3 F , <br /> Proposed Use of Structure/A dit on: {�pte 51f'le c ? 0 <br /> Anticipated Start Date: 1p `5 aba3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> J <br /> Building Contractor: ) YULiiu 9, ,.kc el 3 Sewer Installer: <br /> z V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY PcJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> o MQtr- 01 Se,-0 0,(1%. 4o.1-4- Vvt -Land Se.--bcu,i- M,u,S+ \X tvk.,f - - <br /> rt.% - 40 b P. u s d k tiuktv w., V 1a)o► 'w. <br /> lz°23 ? Fee Rec: 50� <br /> Jf k` UA U1,41, S ,{ I o Sq.TL. nee Landd p (Yu+ b ▪ Check#: 599 <br /> tn <br /> br *0 6.t. rurn.uveA arc( conS+-vsuct-i Y1 <br /> z <br /> o <br /> / <br /> Date of staff site visit: !D 11(4/23 Ini 'als of site visit staff: m J <br /> r- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: V 7 ji > Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <§ 0 <br /> z � m Hi <br /> C' rp <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m"e ^' <br /> o <br /> cp <br /> m .< 1 <br /> Page l of 5 < �, <br /> Burnett County, WI Land Use Application—Rev 5/2023 0 3 <br />