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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) a <br /> C7 Q3 <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O 1 <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 /> Filling/Grading $150 Boathouse $500 v) <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. ■ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ' 4 <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. <br /> z <br /> II o <br /> Property Owner's Name: I 7 L . 1.5 " L-Z-C� =' '� <br /> 0. <br /> Property Owner's Mailing Address: Bra 13g 4-- 25'" AV1139',07 IA): J v / dCit State Zip "' <br /> Property Site Address: 2(„y I GIZI n G0�-L - 1•d a•_ <br /> Contact's Telephone Number: -7 is-"` - 2 1 — 2-'ist 0 � d° <br /> Contact's Email: ✓ t r • ('lv I5� ( ' ley) ci: f• C,;,`� CDV'o <br /> **If staff has a question about this application,y6u will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> @BurnettCountyWI.gov E. on <br /> N <br /> Legal Description of Property: A/ Ai ' ' // 0.3. <br /> Section#: B Town#: P eir N Range#: / L/ W Town of: jC(,, "j `4 <br /> *Attach additional page i neededfor lengthy description OR attach a copyofthe deed OR attach tax system propertypage.* c F <br /> P S .f 8 Y P Y PB * � i3 <br /> rr-- � _3 <br /> Tax ID#(1-5 digit number;found on tax statement): IQ(Q 23 Y-• f) <br /> /J� ( -3 <br /> � :s <br /> Proposed Use of Structure/Addition: 4 c 5 ��---f,�t" <br /> s <br /> Anticipated Start Date:Done_ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W a2_. <br /> Building Contractor: Sewer Installer: 6\ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z N <br /> m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -C.- <br /> V" <br /> 0 PAVA all St*b ick-S <br /> ;401.01 , S- OrCty-f 041 <br /> JNo+ -fo be,uS -for \A liboo <br /> Fee Rec: <br /> c Check#: l/376- <br /> m <br /> z <br /> v <br /> m <br /> Date of staff site visit: I1 7/2023 Initials of site visit staff: T— x <br /> n s <br /> 4/2023 <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: c, cni,cu <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z c a �1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT P' <br /> Page 1 of 5 < CD Ij1f <br /> Burnett County,WI Land Use Application-Rev 3/2023 v - �L JJ <br /> a <br /> ro <br />