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ro <br /> LAND USE PERMIT APPLICAT —1 ve N.e � az <br /> r b <br /> Applicant Complete All Sectior ��/ I c w <br /> Permit Types and fees�Please,check appropriate boxes) • <br /> ("�,V► �?,y„D i 1�1 OC L. a• . <br /> X —Q`� <br /> Dwelling/Principal Structure $300 Additions <br /> Commercial/Industrial Structure $300 Addition) 0-1I/4k ( s . O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/ 1Z�yh.�6, cy ( `� o �' <br /> t(.�6� C� f1 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhow �ll� ����� o< <br /> ��Driveways/&Campground Structures $125 WI State: D � <br /> Filling/Grading $150 Boathous �l <br /> `� A <br /> Solar Panels(Stand alone or roof mounted) $150, Permit Ex I AD <br /> 5 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begu <br /> *Communication Towers,Camping Permits&Signs require a different apple g <br /> *Items not listed above will be treated as accessory structures,such as:pen 7o :• <br /> p �`(� OX a C�ni 1S �PL1\ 11 2 <br /> Property Owner's Name: m <br /> Property Owner's Mailing Address: 45u° -6 \c h.e., fiocA-ilwa Lb r( I ,e v n t'v <br /> Property Site Address: ll5j Il c �,r �-�I `/ c ' <br /> p rtY -Tl� (\C�'l. Gt'�► a W�,L We/ it C �jn spz o <br /> Contact's Telephone Number: I D "1 Ogi 501 a <br /> Contact's Email: ('C \3c -e , 1'L w-, (9 c o . Corn � <br /> **If staff has a question about this application,you will be cot-hatted via email. Make sure your email address is N e <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> • <br /> @BurnettCountyWl.gov ao N <br /> d <br /> Legal Description of Property: \CA1{ ,`c \` Odd \\\ I 8 <br /> Section#: Oc Town#: LA© N Range#: \S W Town of: ,CI.CK SO rl <br /> cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> _ <br /> Tax ID#(1-5 digit number;found on tax statement): (OUq \ 7 t7 <br /> p �01�E H <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: \1 I ..(Y2.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: ,CJk C Sc r' \ 'coins <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 6 No74 A ex Gem 3 6 e_deo o i s 'CA' . /9/T/— 23— 2 2 `}. <br /> gZ D viv o y • v im e t& 1 i /A elVit- Glecrr'¢n�__ /^ee y/tee.-rrl r r4 � <br /> b / / ) x Fee Rec � <br /> l0 �/1�S G CU% / 5 a/f O W P o ��11 N I ' f m• Check#:CG$l'1 <br /> a Conte)/7$frtQ / (,>'Se- <br /> z <br /> v <br /> ru <br /> Date of staff site visit: 10/23/2013 Initials of site visit staff J <br /> Fi r—CA r <br /> er <br /> �' U 11 APPROVED BY LAND SERVICES OFFICIAL: DATE: a <br /> CA UPON APPROVAL: APPLICANT MUST POST COPY OF > CD m <br /> z CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N C <br /> Gvri71a� U13C �HStcc d' � mto4in 9teay' Pe l4�; Page 1 of 5 m ff <br /> CD `.0ff <br /> Burnett County, WI Land Use Application-Rev 3/2023 0 ' �� J <br /> a <br /> b <br />