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I s- <br /> cn C - r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a ib <br /> Applicant Complete All Sections Below This Line 3 <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 _/� 0 <br /> Di., Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 • knr <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < ADriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c r <br /> Filling/Grading $150 Boathouse $500 x <br /> CCD 111 <br /> Fa <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. <br /> V./ <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. o <br /> z <br /> //�� r� DO�V <br /> ND <br /> Property()Wner'c Name: CJrI/I�Ie t-s- -Ti-n <br /> N I, <br /> c \ <br /> Property Owner's Mailing Address: I WO PDvL1\ S d N(.,/ 1440( PW STSA1 bE. I <br /> /O' .U 1,1 Kv City State Zip ° 1`. <br /> / <br /> Property Site Address: •k. �ci S3(,Dru.� C <br /> • a <br /> CD <br /> Contact's Telephone Number: lsIL- 710 719 7 a. <br /> d <br /> L <br /> V Contact's Email: r d` r J� 0 CS t"t VC. cow <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .Iv s <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov b0 <br /> 5• <br /> Legal Description of Property: 1-01-s 6 t 7 0 in d oQ <br /> Section#: _Town#: 410 N Range#:_Lii_ W Town of: 01 SCul)- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 1739 S d <br /> Proposed Use of Structure/Addition: ,S ra'v� 7 -3 r. �� <br /> Anticipated Start Date: y/1y/4 c7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z r-C --D <br /> Building Contractor: De04 ,1w14.4� Sewer Installer: 7 0 kJ) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �� <br /> O me.ec- au sz-4-ba.c .S CI <br /> rn <br /> (2)NO-t- +0 be. cased -Fbr Inwn,u rx \(10 bi 4-e4--, to 1 s-torum or16-t y <br /> Fee Rec: -6 ` <br /> Ca ro con-lal r e,r 40 6_ c2, ov e,ci or r_' rn,i 4-- Knni °z Check#: oe <br /> r- <br /> tX,f ira-h'&i da-I-e , 141212026. <br /> Date of staff site visit: ii I hl/2 Initi is of site v' it staff: 4- 6.,� o r <br /> cA m <br /> _ y <br /> APPROVED BY LAND SERVICES OFFICIAL. TE: Q <br /> _ __ Jg12625 -i <br /> m=' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 = <br /> C. - <br /> Burnett County,WI Land Use Application —Rev 12/2023 ��- JJ <br />