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r <br /> LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees(Please,check appropriate boxes) a Q <br /> d �1 <br /> ,)Cd Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '-',-C.-p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 41 <br /> rt <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 '1 <br /> rn <br /> 113 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 i <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> `-o <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 /> z <br /> p <br /> Property Owner's Name: Lc rry -511e,'t Me-31- o W <br /> / o <br /> i <br /> t ^ ( 1 2 00 <br /> // <br /> Property Owner's Mailing Address: It / '`�^c >t Ot,tlt Q�s cs i/� <br /> n City State Zip ° <br /> Property Site Address: Z3ef 418 C c,,,rp '•/^ �► a N it <br /> CD <br /> �L �2�: v - —7 l5�^� G 21? <br /> Contact's Telephone Number: t3 �' <br /> C7 <br /> Contact's Email: bree fey Cae-1 ca. .1S4,,. _...CI r44,4'1 .d ca'— CO <br /> **If staff has a question about this application,you will tli contacted via email. Make sure your email address is N ,0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov tl° <br /> 5' <br /> cm <br /> Legal Description of Property: cit Pam- C>C V 4c.41 6cg A4t) [Og, eofi L C s Li.S-P 2 7 l o 5'/ <br /> Section#: / Town#: 3 e N Range#: /-, W Town of: (a„,i s a' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* Dc ,,, <br /> — - <br /> Tax ID#(1-5 digit number;found on tax statement): Z 5 Z- '/ — 3 <br /> d <br /> Proposed Use of Structure/Addition: /4e-r c_ y <br /> Anticipated Start Date: -/-Z.4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: f°5f t.1 A--i. esse,- Sewer Installer: ttl4)c_ gi s{toA"5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rt z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: › pv V' <br /> 0 //o� all�O� ems fi��, vrne- z 3/9 <br /> �t1iCI LI k_ e'' SI2 o60T�DD �^ �o /�t e,f0' /4eiYltA y <br /> AD <br /> 0 ' v ec ,14 'e <br /> IA c� /}SSI.I�ci 011 Li/Vat, '4. <br /> t, � .z 'O3 ,, Oi Fee Rec: 3 <br /> sct IA i V y ° Check#: t f jJc:� <br /> AA,Y/1�1 H� 4074 r_i -__3q86v <br /> � <br /> Date of staff site visit: 0972°29 Initi of site vis' taff: /_ 4. rr <br /> APPROVED BY LAND SERVICES OFFICIAL: ____ DATE: 12,3 21,a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0o o°C <br /> µ C 2 <br /> IV ffil <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2023 WNW <br />