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LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o g et— ' <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> Dwelling/Principal Structure $300 2< Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..W 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a Cwq <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c I` <br /> (x.1 <br /> Vb <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> Filling/Grading $150 Boathouse $500 rn <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 '• t <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> i-4' _Ii__ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Q l 0 1 <br /> Property Owner's Name: �e�Lr��i( O T Q C1�-c Qe A'I/ 1-I a oN <br /> Property Owner's Mailing Address: V 7/ GA bl h d w f I'"r �J3 7 Cil <br /> n I • <br /> p City State Zip E —o` <br /> Property Site Address: 1/C/q /q CC u i A L A o y <br /> Contact's Telephone Number: a. <br /> o <br /> i9 <br /> Contact's Email: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,V <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and cry <br /> @BurnettCountyWI.gov °C <br /> f� O <br /> Legal Description of Property: Nit)-NA.) QS'G C 144 II' P, &7 a__ <br /> Section#: 2-7 Town#: 7 O N Range#: /,J W Town of: —)at e'vI v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* N o x <br /> ti <br /> Tax ID#(1-5 digit number;found on tax statement): Z.2— J1 <br /> �� / r P `s \-` <br /> Proposed Use of Structure/Addition: ,%i?,rj`7©11 f%j i A t°/11 c a' Q ) <br /> Anticipated Start Date: (xbme/Cabin;Co mercial Busfness;Bedroom;Deck;etc.) \ <br /> Building Contractor: <br /> Sewer Installer: VVV ir+ \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z % N <br /> A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ns. <br /> 6 Isis " 5e- QPProv per GUP- 2- -OZa, <br /> 0 19r/o,� Gil �Nc,'��05 per - 2 - 7Z.0 d��� x y <br /> , / A d , "/ O/A Q ✓Aci . ` = FeeRec: N/� <br /> TG�I's Pe,,^1�i f , s -�►^ e , <br /> _/ o Check#:.----- _ <br /> • <br /> 10 14)- "A o� apP"' VAR R - a -(51/s '�_� <br /> rvi <br /> Date of staff site visit: )21?/ ZO L3 Initials of 'te "' ' taff: v// <I <br /> APPROVED BY LAND SERVICES OFFICIAL: 4.--. DATE: 37 SYZ17 a l 61 m <br /> H ` <br /> ><, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o ( u SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1 Q <br /> C1(GOp 94dl/(S p� Vf'A - Z1t-Ol. Page 1 of 5 <br /> mi <br /> a0,0P 'l// Burnett County, WI Land Use Application—Rev 5/2023 JJ <br /> E <br /> b <br />