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LAND USE PERMIT APPLICATION —Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line = o w <br /> Types and Fees•Please check appropriateM. <br /> Permit T yp ( 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 Z <br /> >Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 t� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) ,r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Fee i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c W <br /> Filling/Grading $150 Boathouse $500 <br /> cii <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a E. <br /> t. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal tee. ., <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1; P <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: �Aw 39 , 0( () oIV <br /> Property Owner's Mailing Address: 717 5 . u\j `,�,1(�.19 Sett, to; L7z F.. N <br /> City State Zip 4 N <br /> Property Site Address: c <br /> Contact's Telephone Number: 7I 6— 5, , 01-7 6 _ a <br /> N <br /> Contact's Email: i K t Camc aCamro <br /> **If staff has a question a out 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 0 0 <br /> @BurnettCountyWLgov b 1'-- <br /> Legal Description of Property: )t)ft <br /> C JVA VI,- fF✓`� - oo <br /> 1 <br /> Section#: ) Town#: A) N Range#: itt 0 W Town of: v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o H E >. <br /> Tax ID#(1-5 digit number;found on tax statement): Z� ivb <br /> /� SvProposed Use of Structure/Ad itioni• — tAS ? It .\k- W( �te_ -c ,�Anticipated Start Date: �/ f�` �Wome/Cabin;Commercial Business;Bedroom;Deck;etc.) F.(1)'' <br /> �0 <br /> Building Contractor: N i- Sewer installer:A.) 4 z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> frite.f. COU S.+loaC.k sLe,. <br /> ENO 40 be (A,se1 -For human hab - ri, S-(t7rne 0 b7 <br /> ./ , 4-,,1tk <<dS 62- St.C.cilU IMTV` A tOC. t lrtJ t-'4-c6 1 by 2111ZDZy -, Fee Rec:1 <br /> 17 <br /> LOIS 40 b't Gornb;12ed Via cer kc d Su111tif *IP '1V rn.ak-e- '7"Vtx S ety d Check#: (-1'2_:7 <br /> rn <br /> alWOM161 b y ) 1 12026 <br /> o <br /> Date of staff site visit: 12 12l nzs Initia s of site visit staft` < m <br /> APPROVED BY LAND SERVICES OFFICIAL'% cm H <br /> DATE: /2/13/2023 `c° Elm <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ) <br /> a a o 0. <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT � .... _. <br /> Page l of 5 -1 inJ <br /> Burnett County,WI Land Use Application —Rev 5/2023 d �L <br /> --I <br /> a <br /> -0 <br />