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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line Ni,CD <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Fo <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ),,? p <br /> A Accessory Structure(Garage,Shed,etc.PcO $150 Addition/Alteration to Accessory Structure $150 <br /> ., <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 /> lb <br /> Filling/Grading $150 Boathouse $500 , <br /> 11, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <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 /> Property Owner's Name: ► v i(,1.�cue ( <\,,�; SCa-� .� i v�) °o N •-0 <br /> • <br /> n C- <br /> Property Owner's Mailing Address: 3 OS U„)cst 5%,v,4,ct. i)v6„� ► o,ti,s-tr, Vnki 57 3e7 w, n "Z <br /> City State Zip ° ck' <br /> Property Site Address: 31 1 f, C- L- 14 W ekes , t.0 54 8 ct 3 N <br /> Contact's Telephone Number: 507- 3 i - a(p`-E) ( vlr\,kc) °' <br /> IN d <br /> Sc tnc�r �hcj�('ckcc�v�,_7ct L�,c;tdru>L‘1 . e--0vv1 �, <br /> Contact's Email: (� <br /> iii <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b w <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and c, °Q `r1 <br /> @BumettCountyWI.gov o2 0. N <br /> Legal Description of Property: k c vy.0 1 b: N .-C <br /> Section#: )4 Town#: 4 0 N Range#: 15 W Town of: Ja c.e._S c v1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W .-3 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 4 E 8 8 <br /> Proposed Use of Structure/Addition: S-hpvcx.s Do <br /> Anticipated Start Date:0S-1-0„ c -Cast (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) op <br /> Op <br /> 0 <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY xi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> OMee+ cal S-C-1-10aGks 01 <br /> New S-� ..Cfie Cet ri Ise Late d -%r- irlainc i Gla,61-/dirt <br /> rr S`'1' "L -- 1 fa 0 ilk C()AA ki-14/1 0. `ta Cr1.ci C.ka:t►'l 1,0`( 1 l IZON M Fee Rec: 07) <br /> Check#: rir73f, <br /> F Cu4i1itd SurvtL( map (cso4 -b be camp tf,teci by g 1112o21 -co r v1.-v-1 to+ ai <br /> CA(1e9ti rcth61. z <br /> Date of staff site visit: 12'I I Z3 4 I 2 ?/23 Initials of site visit staffer <br /> L <br /> APPROVED BY LAND SERVICES OFFICIA : Q 1 , DATE: /Z 20/2623 <br /> @w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF -g- <br /> o <br /> Do ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r G <br /> Page 1 of 5 < mNil <br /> Burnett County,WI Land Use Application-Rev 3/2023 0 �0� <br /> -3 <br /> a <br /> 3 <br />