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LAND USE PERMIT APPLICATION - Burnett County, . r <br /> y, W <br /> _ Applicant Complete All Sections Below This Line o' <br /> a <br /> CD c \v� <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> --- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 pp_ 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 5 \e•\ n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewal ;5D" Bunkhouse $250 • ° I• <br /> Driveways/&Campground Structures VlalitWI State Statute 59.692(1v)Structures $350 &._ er <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 e. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <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 /> N o <br /> , c, <br /> Property Owner's Name: l ` csi-1 1 o V" <br /> 1 a. <br /> Property Owner's Mailing Address: 1 ij.r $ Vt J .;i(, I . . <br /> State .Prop Property Site Address: 1�(6 �� "\\ ‘UW Q,\Jf <br /> - 1„�" 'JnW <br /> < <br /> o c <br /> Contact's Telephone Number: t1 JZ 461'0 02-1 a <br /> Contact's Email: C JCL ( e 5brr \r1\5 • �o <br /> **If staff has aquestion a�iout this application,you will be contacted via email. Make sure your email address is <br /> N ro <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and ° b4 <br /> @BumettCountyWl.gov co <br /> r d <br /> Legal Description of Property: 1-"Cc f Z,3 /�— t�q .... <br /> �. <br /> Section#: 7 Town#: �(Q N Range#: W Town of: 6 a triCi,Pfd_ v) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ` <br /> 7 H <br /> Tax ID#(1-5 digit number; found on tax stat ment): 1 if 3 !° ' J o <br /> Proposed Use of Structure/Addition: \i S LDL `f Q,.\o34 coto-f-tc o �) H tir <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedro ;Deck;etc.) <br /> Building Contractor: Sewer Installer: W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A <br /> m d THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 17t/5 /5 an a eN' -Y4f-- lqv c-7L bt-,.T <br /> 0 Tj l's P cir w•,'4 f$ 4r 7l—A 74-44 Lt/'$ c'o ur a h c/ /i A, <br /> cLe c /_ h eX 14€- 7`e-� �, Fee Rec:,�' <br /> l� ��s �Ur� ' 5.12 Check#: Z$' <br /> 0 TC-11h l, (ur{ b)a5 wro g ea/ 7I-o MW1- /D f 5/.e 5elk ji <br /> v <br /> Date of staff site visit: 9/Z.5/?C Z Ini ' s of site visi taff: //f rn <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: //2v5/Z9Z9 rn <br /> C� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' = Co� r <br /> W to <br /> -3 (t) c c-,> _, a <br /> O co - llul <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT x o <br /> m fs7 Inn <br /> Pagelof5 < 2 <br /> Burnett County,WI Land Use Application -Rev 3/2023 v )J <br /> a <br /> 3 <br />