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LAND USE PERMIT APPLICATION - Burnett County, WI P. <br /> b <br /> b <br /> Applicant Complete All Sections Below This Line o. <br /> Permit Types and Fees(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200cD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.j '1' Addition/Alteration to Accessory Structure $150 b <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 IN Rs <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o fi <br /> Filling/Grading $150 Boathouse $500 ') <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> (*COTE: er- e-act permits(permit acquired after construction has begun m ices tie normal fee. <br /> *Commu ion Powers, amping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such os:pergolas,landscaping,etc. ' <br /> z <br /> Property Owner's Name: a �-� c �L ,.,n Q ��fr L`Ill =' •. IN) <br /> rrVI P <br /> Property Owner's Mailing Address: k de <br /> •=nc S .reff - i14,1 t1't J 55/02 1 N `1 <br /> �/ JCCity State Zip 4 NProperty Site Address: ' 5'6 L 1 °�'n& ) JD t'N ti,�( s [/ c) / • <br /> (� 1 a <br /> Contact's Telephone Number: 1i( 4 -. ?2 1 l ( 0 r a <br /> W d <br /> Contact's Email: �1<-C14~ ) (orr) CL.,S± • in et— co <br /> **If staff has a question about this application,y will be contacted via email. Make sure your email address is N b t <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o cm,@BurnettCountyWI.gov 00 C' <br /> Legal Description of Property:Le - LI am V l$ P195 L&c f La T, POW/Q-4/ PINT' • <br /> N-HA IAJCO S • <br /> Section#: .' l Town#: 14 O N Range#: vj (.1W Town of: C))ev b‘eN 514.15 QI V <br /> P'SN6 `) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* _ <br /> o H <br /> Z � N , = d <br /> p. <br /> Tax ID#(1-5 digit number;found on tax statement): \1 <br /> Proposed Use of Structure/Addition: 5,1e,UA - 4';' ,,,,k J (�_ e,r ,,,C� H <br /> ....4 <br /> Anticipated Start Date: � t v Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc) .0 N <br /> M <br /> Building Contractor: Sewer Installer: <br /> O ---.1---.1AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMENTS/CONDITIONS ONLY z <br /> � <br /> THIS PERMIT IS STTB.JFCT TO ALL CONDITIONS LISTED BELOW: I <br /> (I;2(e-I au .COiac,,L S .- <br /> � ND4 4 he used k hI42; 51DrrifXai4 y x Fee Rec: l— m <br /> — <br /> o Check#: 155 <br /> m <br /> z <br /> z <br /> 0 <br /> t <br /> a � ) <br /> Date of staff site visit: `4 ZD2y Initia s of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: I /i' /2cZq n <br /> m c° V,,Y NJ(J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z a <br /> N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I. <br /> Pagelof5 < a, nil <br /> Burnett County, WI Land Use Application—Rev 3/2023 v L` <br /> a <br />