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LAND USE PERMIT APPLICATION_Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line _ ro A <br /> Permit Types and Fees(Please,check appropriate boxes) y a C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure ($200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Ln <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> l (1; <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ..-o n ,� <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> lb <br /> Property Owner's Name:TQrf S CL.c'hy6 , .COh 2ni2 CCU \ `1 F NI <br /> a (A1 <br /> y� <br /> Property Owner's Mailing Address: 2�S (F ph VS Cycle 1 y` !•!° fvotr'h/ rlY6 ?1. n N1 <br /> CityState Zip '" N t <br /> Property Site Address: Zd tt-{'D (302->�tit V SON 1jj14114%Lit—� "7 Z c <br /> Contacts Telephone Number: Co A` e_t cle'r `7(c) pit lc s I 3:::. F i5 <br /> /' t-Y <br /> Contact's Email: l�rc41 + G:-S4. . , .eS(cj r1 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N , N <br /> legible and your email provider will accept emails from the following address: (BurnettCountyWLQov = o 1.--___.Q <br /> N <br /> Legal Description of Property: �Cr 1 4 Z � iv `n`i (�i 3 � 3 l/�i l Pc, i E' <br /> Section#: ,l Town#: Ha N Range#: I tW/ W Town of: 00Ph✓A. N <br /> *Attach additional page if needed for lengthy description OR attach`--T}a copy of the deed OR attach tax system property page.* C4 W <br /> Tax ID#(1-5 digit number;found on tax statement): 3 11-c) <br /> Proposed Use of Structure/�ddition: -] W <br /> `C f' <br /> Anticipated Start Date: ! i.,t ' l4 2_4'2—tome/Cabin;Commercial Businness:Bedroom:Deck;etc.) (-- ..0 <br /> Building Contractor: f�Ak✓e- 6✓ eti 5 0,1 Sewer Installer: Lc.* (241-3 I(-›'L-if . t 0' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY - z p— 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> a <br /> 0 Q& O .- O <br /> i s addl'h� cauin D-� exceed �ec�ro6m S 1 �, <br /> 18� r-ri (r <br /> 7 Fee Rec: OG!/-htin \iCI 14-1- Cc ii, m-E- uce `/l fD z Check#:d(3't//.2 <br /> Parcel +o be CarnbiKed -l-h ( io�y /zoz A <br /> Date of staff site visit: S/i' /2021 Initi s of site visi staff. 4-bit. <br /> APPROVED BY LAND SERVICES OFFICIA : DATE: 2 J ZZ 2 (��7 <br /> n z EN <br /> Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Z <br /> CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o -4- <br /> CD 0-0 = N o <br /> Page 1 of 5 3 <br /> Burnett County,WI Land Use Application—Rev 12/2023 z <br /> C-= <br />