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LAND USE PERMIT APPLICATION - Burnett County, WI c 1-, <br /> Applicant Complete All Sections Below This Line 0 g ' <br /> .fit Types and Fees(P/ease,check appropriate boxes) <br /> \ G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 S VI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1E0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> cip <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `5 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. f <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S 74. <br /> 11, <br /> z <br /> pp�� <br /> Property Owner's Name: O I_F � R&S C P'CTS5.1 N' 1 o <br /> '=7 N vN,, <br /> o <br /> a. <br /> Property Owner's Mailing Address: 3 3 117.4) /4 1i'€ J, '�� (IQ 55 b -. V <br /> n <br /> City State Zip ° `� Ul <br /> Property Site Address: l3 7 5 Rw2, u u Tot - Tet..�.ib,'iy k.i 'i,S Y 130 p o y �� <br /> it 3 1 • <br /> Contact's Telephone Number: ���S�$ 9 <br /> �/ <br /> CD <br /> J d <br /> Contact's Email: ICI IT i1��' <br /> -C� S L�'b` LA-1/4-G� t == <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °O <br /> @BurnettCountyWLgov (� (J D Z d <br /> Legal Description of Property: 1- 2. (- l Cfl S �i A 71 1 �� -) . IN <br /> Section#: 04) Town#: 110 N Range#: /q W Town of: t.c W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ;.% o <br /> i� 0 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 'j tl 3 to I d <br /> y <br /> Proposed Use of Structure/Addition: Cdi4�(/�. <br /> Anticipated Start Date: �r:1.�(yzto Zi{ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -.J <br /> Building Contractor: Iw re ed.,I5evr Sewer Installer: ti-op,u,vt.S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z N <br /> THIS PERMIT <br /> IS SUBJECT <br /> U T C T ALL <br /> CONDITIONS LISTED <br /> ISTEJ BELOW: � <br /> Db ;k Moir -\-o aceed 3 \XCirr-Ont Pu S -23-266 <br /> Fee Rec: <br /> 5bm <br /> bMitk 11 no- txmd `l ki" l Q,l5 7_ aSil'IC,7�7C�"�) G n / , ' Check#:f Z 2Ls <br /> @ &ANN -41)/WOW 1/10A)-S atuAlAn., i\ co g <br /> z , <br /> ) Jj , <br /> CA <br /> Date of staff site visit: 5111/zoz Ini . is of site visit stai'F!l� 1 �4- L s _ i <br /> a. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 11 I /2tIL'1 m W_ = 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF zoo O <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rg. °z N <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 v �� JJ <br /> a <br /> 3 <br /> -o <br />