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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> Applicant Complete All Sections Below This Line s CO <br /> Permit Types and Fees:(Please,check appropriate boxes)', I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 irpok <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> Filling/Grading $150 Boathouse $500 <br /> v; <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `� <br /> -o 1111 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 5 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -. <br /> z ' <br /> 11 <br /> Property Owner's Name: S C.o f IL G✓1 a -e✓\ e-., m V S e r o a <br /> pi, 2 <br /> c <br /> Property Owner's Mailing Address: g(„ a2Co • tGCK Eva,- fe,, .>hal wry (,t/1 S6/83,6 iF. n s. <br /> (� <br /> (- City State Zip () ■ <br /> Property Site Address: g(pa Qj 6 ,OtC K tear +R_• bQ 1'4au r t/ ud 1 .5 f '30 T o N II <br /> Contact's Telephone Number: -VS—— 7 1 1- 16 QC) ro <br /> G. <br /> t , <br /> Contact's Email: C e Yl 9330 1 i hock - �'1`C <br /> **If staff has a question about this application,y will be contacted via email. Make sure your email address is N .n <br /> o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °0 <br /> 5 <br /> @BurnettCountyWl.gov (Jo. <br /> i <br /> Legal Description of Property: Wa C< �QC(r CI3-re S Lot. <br /> Section#: -3� Town#: '-)/ N Range#: ) 1 W Town of: ._.5 WI5 5- 17C) cr <br /> *Attach additional page if needed,for lengthy description OR attach a copy of.the deed OR attach tax system property page.* wo <br /> Tax ID#(1-5 digit number; found on tax statement): j.Q 5 -7 0 i� <br /> Proposed Use of Structure/Addition: Syra 5e ..0 C. <br /> Anticipated Start Date: 'MC�1. i 1 9-Ua'-) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v+ <br /> Building Contractor:Qw1-P0CA vl Sfe‘e l ea( cIr+ Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> D 1 uuA- OM Se-foal S .J <br /> ',lab:,4--ccti on <br /> ID siucts ccuinb+ ht kits-ect -Ft(' titut nil ctAl <br /> I� I geed/ �f yin, / �p Qw'ea � 1'i{�2i � FeeRec: �,�•� <br /> ()Land Use Perini IS u iWc �a C4 Check#: iv 9t'v9'.� <br /> en• oft er �i//�C <br /> Date of staff site visit: 5/1 /all Initi s of site visit staff: 4- <br /> T <br /> n <br /> 51�� /2D2yc� 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: rz fr c <br /> a < 3 'n�, <br /> a w Uul <br /> — <br /> v, <br /> Page 1of7 z c3o c o <br /> Burnett County, WI Land Use Application—Rev 5/2023 i <br /> 1 N <br /> m 0 Ind <br /> 3 <br />