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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> • <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(P/ease,check appropriate boxes) . ad <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure ,($.2D8-i' v; *tO <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 G-. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 11 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> 16 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Q r.: <br /> sl� ° , <br /> Property Owner's Name: e✓r ti =' <br /> d <br /> a <br /> Property Owner's Mailing Address: /O1 1& ( ' n er Z N . A�/o/r L/J/�j M%U 5.S/2c/ n W <br /> e l City State Zip <br /> Property Site Address: 2�j,2(7 ( ,ad. /1 . //+n A(4'/ w E < <br /> —� •o c <br /> Contact's Telephone Number: �s . 11, '— Z.—C.86 a <br /> —),l d <br /> Contact's Email: l f� je-i�"75 ' 6�o j 1"'--i I/. rc"'^ `= <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 addresses: @BurnettCounty.org and °o 00 <br /> @BurnettCountyWl.govOM <br /> Legal Description of Property: W1- [ CSM v 1 Q 19 2 (LN (J Cc)T Sfl <br /> Section#: ! Town#: I/O N Range#: /`/ W Town of: S C f 7�/Fi. 6�''i ro. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r <br /> N <br /> Tax ID#(1-5 digit number; found on tax statement): E <br /> Proposed Use of Structure/Addition: Ho �/(e E'+''" <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '� <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 05q9-tic -f an k -/o be moved 4o m:e,2.4 6c SJ- cia- -� <br /> O p (1q r�o+ 4o t.kc eed 2 Iotd?-corns u.l-h ( sailI-I-mcv puck �- , �r� <br /> J ? Fee Rec: 247F <br /> I S Ok.4't1 t d jO( Q�C�t�1 �� o Check#:CA 4 <br /> V v m <br /> r <br /> a <br /> z <br /> v <br /> Va <br /> Date of staff site visit: 51«I2aq Initia of site vis' sta `d- 9)L < l J <br /> APPROVED BY LAND SERVICES OFFICI �j ATE: 7/12 Z0Zy cm ITH <br /> cm <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 6 g <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 3/2023 5 Iriiil <br /> y (..` JJ <br /> . z <br />