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LAND USE PERMIT APPLICATION—Burnett County, WI . r <br /> b <br /> Applicant Complete All Sections Below This Line 6 CD A <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> C 4 <br /> Dwelling/Principal Structure $300 > , Addition/Alteration to Dwelling/Principal Structure $200 <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 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 k <br /> c <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 ^ . <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 <br /> k <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '• <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. t~ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: 0.✓; a m ; "s o <br /> o -C <br /> a <br /> Property Owner's Mailing Address: 33 (o S"" W; leC -1i•.•t Cc'<-tt rva•i P--Qc‘(.fir I'1,,�/N SYo 46 1 <br /> L City 0 State Zip 4 <br /> Property Site Address: 2 C/D O 5 lr1 C.. Ke-K Z i e_ .o4 t S Poo I.)tr 1 5'19O( o ti <br /> Contact's Telephone Number: (p 12 -7 Z 3 ' `f' (O a. rl <br /> 5 mat..sue d"tei N.Contact's Email: c\.e4.. J c. C. \--4 O\AS 33 . Cs G.., ( •urn .o r)t-(o 4^S b <br /> **If staff has a question about this application,you will be contkted via email. Make sure your email address is N a <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov a 00 -' <br /> B' <br /> n,c ao <br /> Legal Description of Property: PGL SW NE C <br /> Section#: I I Town#: `l N Range#: iy W Town of: ` ,' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* to <br /> N z <br /> Tax ID#(1-5 digit number;found on tax statement): ��$� a d <br /> Proposed Use of Structure/Addition: GGV‘ 18L.-...i 11.o w5.(j 0,- -i J <br /> Anticipated Start Date: 0 (Home/Cabin;Commercial Business;Bedr m;Deck;etc.) <br /> Building Contractor: Sep P 9 <br /> 0 fr,on.e IC Sewer Installer: CI <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rz Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> C Me of ciD se- r k-s w <br /> CI pinf,te lrl not -+o .yr.2ed 3 ►mod,-obrrlS fe, San;-bury Li2 cti a Fee Rec:acao°� <br /> z Check#:bcf3 a. <br /> lei Look ailc1 cii needed 01 S.f,r-tic -Mak lid by (9/!5/Zazq r <br /> rri <br /> cri <br /> Date of staff site visit: +vi L d��I� �Zy Initials of site visit staff. —___.._a, <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: 5 2 ZVZ1 Q in <br /> Q <br /> v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w (; <br /> Page 1 of 5 C .1-u-l. <br /> Burnett County, WI Land Use Application—Rev 12/2023 -70 <br />