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LAND USE PERMIT APPLICATION— Burnett County, WICr g <br /> y N <br /> Applicant Complete All Sections Below This Line 5 <br /> n <br /> o. <br /> Permit Types and Fees(Please,check appropriate boxes) p d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> ki Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 C3 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 (71 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o Q <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 coo43 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 =• c <br /> P <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. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o —. <br /> W <br /> Property Owner's Name: :>(A___y_ce S S i�1'l -'��tnz-` ''AA� ''��ll o N c <br /> 0 <br /> Property Owner's Mailing Address: /vv �; 111 S I c y /V`TI Ah 31/c 77. n J <br /> City/ <br /> cp <br /> Property Site Address: 3�-1�-1 A . c. Po L'O hS tr,Sta c6 13 o <br /> TS <br /> Contact's Telephone Number: (2 I A — 9 !cl — '762 S' ( l d <br /> i <br /> la <br /> Contact's Email: �-h U he-'�T i- C"?- CV PYIC STJ . ►,e `'' <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 address: @BurnettCountyWI.gov °° .p <br /> s' <br /> to <br /> Legal Description of Property: 3 `-I 6 c ile•j IocLc d 1u <br /> Section#: `11 Town#: Li N Range#: 1 5W Town of: 342 c--K-SO InJ <br /> oZ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> f / .) 1V <br /> Tax ID#(1-5 digit number;found on tax statement): 56.D -L <br /> o <br /> Proposed Use of Structure/Addition: i -fs(e- c-✓^in -i <br /> Anticipated Start Date: 3/2 j/24.; (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x -Z o U1 <br /> Building Contractor: Sewer Installer: AI 2- y 0 — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: s z <br /> MRe,-1- all. Se-Hakc-kS o.re sad -�o bL r2rv" c1 or 31,I sbI < u` <br /> No+ -Fo be uSekt -Po humori 1Aa bl�a%� cib DA t ! a <br /> �� I' aid I^^ ' LL� -�'Q.YI� I,lcI �L( �j l I2o2'1 ,��, Fee Rec: ��a - <br /> Q(C (�u�"n (� Or1Tt C °z Check#:17` 5 <br /> y �a-��o re �►-I- iSSwe Is, be reS()ly-ed- in 2.o2 { <br /> rn <br /> Date of staff site visit: //2(/2 7 Initials of site visit staftr/l ( u!L- d ��L-J <br /> / m <br /> APPROVED BY LAND SERVICES OFFICIAL:�� j�U'�x { P DATE: 2-40-02 y cL 3 u u <br /> b �cco n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> N <br /> .E.- nl-n <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2023 ��J� <br />