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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> o- <br /> %Applicant Complete All Sections Below This Line 5' c <br /> n ' <br /> Permit Types and Fees�Please,check appropriate boxes) <br /> . <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .. o <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 .II <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z <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. i" <br /> Property Owner's Name: �vQjf (`C.-CIr1 VQ,p'\ �� C10 RA 1'r4� SiG1cla1 o _-- is W <br /> Mailing 1-I1b1 ' 11 &� , r t-td Sit F_� <br /> PropertyOwner's Address: �- z <br /> �1 • <br /> City State Zip ° "' <br /> Property Site Address: \ 10-1 I eI�r"e th - ,4o0Y\si-v ‘.Ark 1-k-- 0( z o <br /> Contact's Telephone Number: DI 5 1 2t5(o qS .— <br /> Contact's Email: fZ�eY-C\ -�c� V- <br /> t -. •aV2� C°2_013 cAjv \. COCor' 1 CD <br /> **If staff has a question about is 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 $ °0 N "I <br /> @BurnettCountyWl.gov cm <br /> Legal Description of Property: < ^ 4 F J -}�v,n(.. W <br /> Section#: 14 Town#: 3 9 N Range#: /'{- W Town of: "Z. s... Jk. v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* H— 0 P <br /> - <br /> w --.0 a <br /> Tax ID#(1-5 digit number;found on tax statement): e11.4 °12-21 65 199 <br /> Proposed Use of Structure/Addition: e. Cpvc' *_-tom v'' 4-0' ( 1 <br /> Anticipated Start Date: 1 X 1 %51 a.0D- (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> Building Contractor: X Sewer Installer: _ 4z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1_ <br /> D ill?e-k au StH'9GliS <br /> NDT U YJe - 6Y 111k rYla t'\ lv l Dl(\ S-11)fr-u>Q (x1 Ly z Fee Rec:i <br /> 52. <br /> Check#: / c <br /> rn <br /> r <br /> a <br /> z <br /> 0 <br /> Date of staff site visit: )2/111/2b LIJ/zi/2y Initials of site visit staff:4C----r- <br /> n C '--f <br /> APPROVED BY LAND SERVICES OFFICIA . DATE: 104/� y tr D =CO u u U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 .m ,` n� <br /> r u �+u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0= N o <br /> Al -Z w Q <br /> Page l of 5 • — <br /> CD MI <br /> Burnett County, WI Land Use Application —Rev 5/2023 0 R. <br /> H L` .J <br /> i - <br />