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gv <br /> LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> Applicant Complete All Sections Below This Line e. <br /> 1 Ilk <br /> Permit Types and Fees:(Please,check appropriate boxes) - d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Ir <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 * I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> V. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e k <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F - ---..,6- <br /> Filling/Grading $150 Boathouse $500 I� <br /> Solar Panels(Stand alone or roof mounted) _ $150 Permit Extension(1 Year Extension-Allowed Once) $100 F • <br /> *NOTE;After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. b< <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 6- :» f' <br /> Z <br /> Property Owner's Name: 12244 (, -s ue, j v <br /> E. <br /> Property Owner's Mailing Address: 70� der-44--v'e� p/'• ch.� 6 A - erl C �, m <br /> 3©`2'7�J ( .t`e-i'-'ac� -ccv e ty State Zip 4 <br /> Property Site Address: r` <br /> Contact's Telephone Number: Sdr-er c.,o 7 t-(l 6 — t 3 S— 1 g. . <br /> Contact's Email: �Crc,/4G- -- c.e eort5 v -ter' r'ae'-- S <br /> **If staff has a question about this application.you will be contacted via email. Make sure your email address is N 1 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @BurnettCountyWI.gov uo <V <br /> W. <br /> Legal Description of Property: Al(o F C o F a( e7+f 6501 f / /d('1• Pic. 2!(��(2 a - .,. <br /> Section#: 6;2 Town#: y( N Range#: /5`� W Town of: J`'c.0 63'5- /467 y`l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N c <br /> N�C4 el N d <br /> Tax ID#(1-5 digit number;found on tax statement): 2 , - N <br /> Proposed Use of Structure/Addition:06. c_-a s--s.y _/S v4f_. _ — . <br /> Anticipated Start Date: - 1 J—' - (Home/Cabin;Commercial Business:Bedroom:Deck:etc.) 1 --C <br /> Building Contractor: ! GC'eS-d'1/Girv` Sewer Installer: C <br /> Z <br /> AREA BELOW THIS LIN FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Mkt+ cp ct4 / S , SA-cdct lOcc H toa.s vnoveicl -1-0 mac-1 & .-1-bins- 01 <br /> gN(4 .,0 I2A Riot -roV 11/1AMOA 641444r <br /> Fee Rec: <br /> .*: <br /> Check#: <br /> a <br /> z <br /> Date of staff site visit:m[I / ozq 1/0/0;241 Initials of site visit staff l J <br /> r <br /> j� /� •APPROVED BY LAND SERVICES OFFICIAL DATE:`0 / 2t) / • a) N1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTN <br /> N <br /> Page 1 of 5 • - -0- <br /> 0 In <br /> Burnett County,WI Land Use Application-Rev 3/2023 <br /> J., <br />