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LAND USE PERMIT APPLICATION —Burnett County, WI c b <br /> Applicant Complete All Sections Below This Line = A <br /> o. ' <br /> Permit Types and FeestPlease,check appropriate boxes) G �. <br /> Dwelling/Principal Structure ("$300 Addition/Alteration to Dwelling/Principal Structure $200 re <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X9 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 e <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 j <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < I <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' 0 <br /> Filling/Grading $150 Boathouse $500 y a• <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 to three times the normal fee. sg 41 <br /> ro t <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 IP <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c »' r' <br /> Z <br /> Property Owner's Name: c tf C O Ayrit, Rir--f - 'a Q a <br /> i Property Owner's Mailing Address:� Sn S �o! TO Simi J/ 5�7� d <br /> I , <br /> [�.7bvi" Ed f/"rl�e- State Zip <br /> Property Site Address: 1s La <br /> Contact's Telephone Number: -7/6-346/-2/ ex/ ..1.714 a ‘41 <br /> Iv ,a <br /> Contact's Email:&+9a'yt. (la1,d�r P-- 0btrf'j4 G I' i/Wi. V , r <br /> S6r <br /> **If staff has a question about this application,you will be contacted via ema ake a your email address is N 0 <br /> / <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov °a �° <br /> ^� ' <br /> Legal Description of Property: ?CZ_ GO �Ij' 0 <br /> Go 0 <br /> Section#: Town#: I--16 N Range#: l 4 W Town of: Claklar>la 3' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v,/ •� U1 c <br /> Tax ID#(1-5 digit number;found on tax statement): !� 7 j a o <br /> Proposed Use of Structure/Addition: U�t' 1 4. -a�ated Start Date: C' <br /> Anticipated <br /> p �l� a0 (Home/Cabin;Commercia{LJusiness;B room;Deck;etc.) <br /> � <br /> � �0 <br /> Building Contractor: Uh OW j^ Sewer Installer: Nf A p <br /> J <br /> 4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY eel Z ¢ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> 6 eP� Vq✓'t`c40ce �'36 /973 o1ll'c QJlowQ-Q <br /> co rvevt )L 101,,i'lc4 rp, , --TA-,'s H e to *LytA i'-- i s <br /> µma//e-r Q rid IA,,''>Lt:11tK Tote, Ek/STrPtsi 740/ / PI Fee Rec: 4904e — <br /> 410 AjO f D e u/!P" `6)/‘ A N!M of Pt. G1 a I as vt . z Check#: IVP," <br /> e <br /> Date of staff site visit: i/i g/&2Z Initials of to visit k 7 "-- J <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: //f 9 zoz W <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g a <br /> N 0 "" yi JaY <br /> 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 <br /> co <br /> �' Ertl <br /> . <br /> Burnett County, WI Land Use Application —Rev 12/2023 (, .......J� <br />