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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> < <br /> Applicant Complete All Sections Below This Line 0 c w <br /> PP P CD , <br /> Permit Types and Fees:(Please,check appropriate boxes) .- `- <br /> C7 <br /> Dwelling/Principal Structure $300, Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> 4 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse p ^ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse I IEfe' i a J<- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures i 11 o <br /> Filling/Grading $150 Boathouse $500 <br /> a, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? r--- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. /' C <br /> iv <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. g' <br /> z <br /> _p o <br /> Property Owner's Name: Ae G it/ Le,C A)d.(rI e J R '^� ,/ �./ o <br /> Property Owner's Mailing Address:/ ,- (/7"1`� /3 L '7 i+� Rd Wed r (A)z- S ee- 5"d. �a. � <br /> u ` City State Zip ° E ',v <br /> Property Site Address: ! 79 Q 6 'C-lief ID Rd •o <br /> Contact's Telephone Number: 7 I S—3 ! 1- 0 %'c c <br /> N d <br /> 1 !ylOweg1982 rnci t --�Contact's Email: `�� t0177CD <br /> **If staff has a question about this application,yotvill 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 ° °Q <br /> @BurnettCountyWI.gov <br /> f ,29 P/7/ E. <br /> .---.1Legal Description of Property: Css`n 7 U� .. <br /> Section#:06- Town#:_Sg N Range#: /4" W Town of:P 1,cJe// . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*Sil (v <br /> Tax ID#(1-5 digit number;found on tax statement): /q,j 11 <br /> / y r VJ <br /> Proposed Use of Structure/Addition:_I p2C1 S{J(ce�]�' c'C7 * " <br /> Anticipated Start Date: (Home/Catlin;Commercial Business;Bedroom;Deck;etc.) � <br /> W <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> Q awl-e-€- - a It s eJEia s. l -C <br /> ill Ak7 74. h ,.._ M S 4 K AWM G VI Ael bi 7-c/77CAi OHiy <br /> a S j � off-tZ ..S e Q1 y Fee Rec: <br /> " o Check#: (',' i5h <br /> m <br /> z <br /> v <br /> m <br /> Date of staff site visit: 1 I I Z023 Initials of site visit staffri w L J <br /> tIU <br /> I <br /> I�.,�,L <br /> n <br /> APPROVED BY LAND SERVICES OFFICIA : DATE: l [0/2QZ3 CD 03 <br /> Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z61 <br /> .. friN <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT p fk, 2 Q <br /> Page 1 of '' jj <br /> Burnett County, WI Land Use Application-Rev 3/2023 v LL <br /> a <br /> 3 <br />