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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees(Please,check appropriate boxes) CI.lease, <br /> C7 <br /> Dwelling/Principal Structure $300— Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �K.) 0 <br /> y,Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 \ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> i <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `.$ �' <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. F. <br /> o <br /> Property Owner's Name: /e1 C///A-L C ---1/4/aC —,�" °7, <br /> n. <br /> Property Owner's Mailing Address: 7 co A- 00Ai L /�A) (A -D '5�74/r-r `ti `'t (3 w <br /> y G 67 <br /> a n 1- <br /> 160( Li*I.In Lp,r11L City State Zip v) <br /> Property Site Address: j"L�1-i�+ - eats Cc 0 0 1 e- <br /> G <br /> Contact's Telephone Number: 4, /Z, — ! g—jd 9 "Z_ c <br /> 0 <br /> Contact's Email: J'fKs/A/6 C-z t o Ct0 E CO 1.V`- <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o °o <br /> @BurnettCountyWl.gov ono <br /> t? <br /> Legal Descriptionti of Property: 4/( GG-e c✓ z_4/e&- z. r� E. <br /> Section#: 241 Town#: q D N Range#: 110 W Town of: c,,� L p.^.,D v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N o <br /> ° d <br /> Tax ID#(1-5 digit number;found on tax statement): /4'3y (o 0 <br /> Proposed Use of Structure/Addition: t ai✓, -.0 <br /> Anticipated Start Date: �/ /y/, 20-z y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: jV//ck- Sewer Installer: A-'/A- O -0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> S <br /> Ui€e+ At ;,-J kS <br /> W 40 biz. Used -Fa{ fru 1(14 i-f-a7H bri. ,� 5-e- t°l <br /> Fee Rec: /5O— <br /> c Check#: `.434'2 <br /> m <br /> z <br /> v <br /> Date of staff site visit:12JJJ111�27 �23 Initials of site visit staff: ( rrl <br /> < )J <br /> w <br /> APPROVED BY LAND SERVICES OFFICIAL:XdirlaW143 DATE: i. Z?7ZOZ3 y . ffil <br /> CD C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z <br /> c � <br /> o It trtl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0CI <br /> Page 1 of 5 < a CAI <br /> Burnett County, WI Land Use Application-Rev 3/2023 0 <br /> cn <br /> -o <br />