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G <br /> LAND USE PERMIT APPLICATION — Burnett County, WI cr 0 <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) °' Ql <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> K_ Accessory Structure(Garage,Shed,etc.) `-$ 51 0 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e° IP r <br /> Driveways/&Campground Structures $125, WI State Statute 59.692(1v)Structures $350 0 t <br /> Filling/Grading $150 Boathouse $500 6 <br /> r f <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ,, <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner's Name:_'IZ)/C rr Se - G('2 A .11 <br /> °o W i <br /> Property Owner's Mailing Address/.2 9D�` 4Vv t/ Mt .c* !Zpvi Mv . <br /> / 5S ? w c� JC <br /> /� <br /> Cit State Zip c r" 6- 1 <br /> Property Site Address:4,49 Pia-- ( /)j Jell. i JL53 Wx_ 59293 o y <br /> 1, <br /> Contact's Telephone Number: 743 �-34 D -S 2!8 °' <br /> d P <br /> co <br /> Contact's Email: $,/S ZFer-OeQ L'EA/1i"v2W. iK+i1r <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N _� <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 "� W <br /> Legal Description of Property:C tit. w \12 _NE Jw P N <br /> 373 <br /> Section#: .27 Town#: 3 9 N Range#: /4 W Town of: /1'l F.EMeo .I 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): 3zs0 7 J <br /> Proposed Use of Structure/Ad ition: STo2A3 - -3 W <br /> Anticipated Start Date: V ,20• sf (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z <br /> Building Contractor: Sewer Installer: c7i di <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z z <br /> v <br /> rn <br /> nt+ -w 6, used 4ork.an halos <br /> a0,0 <br /> -� Fee Rec: /�0 <br /> DI bX-1 s4L 413 fie. f e javt,c1 or can l eco-ed 40 Sq-i-I( 5'1 S-k.IYI z Check#: ji it)5' <br /> by 8 f 3o/Zo2q <br /> 1, rn <br /> rn <br /> Date of staff site visit: UA I'°�) Vu Ini ' Is of site visit staff: 1`l�4- o -----T-71 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: f 2 21)27 3 Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF cD a 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 0 ,NJ <br /> 2 <br /> Page 1 of 5 <br /> Utfil <br /> Burnett County, WI Land Use Application-Rev 12/2023 r�- <br />