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LAND USE PERMIT APPLICATION— Burnett County, WI `° r <br /> B <br /> a <br /> b <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees(Please,check appropriate boxes) a a <br /> _ C7 <br /> 11>,7 $ <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 U1 h <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 1110 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures r'pg $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 B. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' ilk <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o . I+ <br /> o ` <br /> Property Owner's Name: Z),.: * L.,4 J t+ 6 -CYIV:,Al ° "� <br /> 0 <br /> Property Owner's Mailing Address: /26 574.1 F gel'i c1 t- F 0 i0 L.t tyd.4)2( OA] 5 i IS 77. <br /> City State Zip W <br /> Property Site Address: 37z4 5< SilA Ng, 0 .A Wz:ETC. tALT. s--ii eci 3 o gill <br /> (y .Z Contact's Telephone Number: � --96 $"1,55 g— E. <br /> PI <br /> 1 1 d 0 <br /> J <br /> Contact's Email: G(-, *Alr (�j t'�V/� Cu f i �etM CD <br /> **If staff has a question about this ap'licai�ibn,you will b j1M ontacted via email. Make sure your email address is N ,b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov = °O Cs <br /> tio <br /> Legal Description of Property: '0 0:74A M L GOT _ p <br /> Section#: ,3r> Town#: '4'0 N Range#: /5 W Town of: JI1-C.JSSO,'J <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �J U) <br /> / _ W H <br /> 6 <br /> Tax ID#(1-5 digit number;found on tax statement): 04 5 "� C7 <br /> Proposed Use of Structure/Addition: IZEto c -Te` G e J 7-c ,j LOT -.3 U <br /> Anticipated Start Date: 6.(A{'1 44 1i ZQ24 (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) p <br /> z d S <br /> V <br /> Building Contractor: f Sewer Installer: iP %!v S l <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> d <br /> 0 rn-et+ au S,c-forks <br /> 2 -1-0xc Peed 3 �S pc( Ste'24-I!0 3 v, <br /> ��►�e 2J1.` 5 n0 <br /> c <br /> DCOM-et(4 Uni. m brN-c!l ay Code (uOG /ns f aFee Re for any r1�C�Ssary ' (:;40 <br /> ° Check#: ‘111151, <br /> m' <br /> rn <br /> n <br /> rn <br /> // o <br /> Date of staff site visit: -7/6 1`--� <br /> /��y Initials of site visit staff: 6/.+1 r1 d <br /> 2 gypgo <br /> APPROVED BY LAND SERVICES OFFICIALS j 4 DATE:7/23 ZITJ2,/ , n <br /> b m03 fill <br /> �( a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> c inn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 0 `� c <br /> co C "' <br /> Page 1 of 5 �. ff <br /> Burnett County, WI Land Use Application—Rev 12/2023 J <br />