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LAND USE PERMIT APPLICATION - Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees(Please,check appropriate boxes) n <br /> AD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> — <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 X) O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ip <br /> Filling/Grading $150 Boathouse $500 CID <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <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. i I\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Pr. <br /> Property Owner's Name: M I Glf 1C)f.1 + .\t\ 100k \'t 7 1 n5 " <br /> /� <br /> _ a. <br /> Property Owner's Mailing Address:,a1 as 7jtQt�, ka b LLQ�.s -Ir (1)j_ St#F39 3 b <br /> _ /� ` �� City State Zi E <br /> Property Site Address:,` l a 3;3 -1 -K C.9 35 J LV �, LLB-L ;9 3 �- o y <br /> �' <br /> Contact's Telephone Number: r]1 5 -�t o-�rj`1�: Or" `lt �1,Q(D 8d r--A, y <br /> Contact's Emai1:L0_3h i+t°t Cat t i LAD t 1 CMG e rn es a c\r`r t^J\ L\\ . c Z`-m ` r° <br /> **If staff has a question about this 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 address: @BurnettCountyWl.gov °Q <br /> o tV <br /> Legal Description of Property: r—eQ oA-"-t _r)n..0e1 0 "� <br /> Section#:349, Town#: 1 40 N Range#: 'co W Town of: Cct_V`C‘_l 1C1 (' s <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o pi <br /> Tax ID#(1-5 digit number;found on tax statement): a ia� 3 N g d <br /> c-A Proposed Use of Structure/Addition: C _N r`rtt),l"IC( r t k clan, (-la,4 �7� ,-3`t GI � V <br /> Anticipated Start Date: Varjpiar: k-1. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> 2.0C-311 (4--)€.4ev-tor-) = v L ...t <br /> Building Contractor:Rrny.0 ReirCf Sewer Installer: 9V i tA4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rn z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o Po <br /> beck ad 3� s2 wP-t- Pa <br /> cn <br /> cn <br /> Ac0� S"hflJlf,' �' R�Q $g.�"� 'Fee Rec:*/ZS <br /> see <br /> °z Check#:SC16 <br /> r, <br /> r) <br /> m <br /> m <br /> < <br /> $/I(P/2M11 N r <br /> Date of staff site visit: Initials of site visit staff: ` l a <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 11f I(Q1202`7 CD W C <br /> -' 3 r— r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> CD C Na <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 3 <br /> Burnett County, WI Land Use Application —Rev 04/2024 L.... <br />