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LAND USE PERMIT APPLICATION — Burnett CuCounty WI a cr-. <br /> — b <br /> Applicant Complete All Sections Below This Line 5. <br /> Permit Types and Fees4'Please,check appropriate boxes) <br /> . a <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 R <br /> n v <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 . °e ry <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 cn <br /> Solar Panels(Stand alone or roof mounted) $150 /--- Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w' <br /> `NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ro 'S <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 7. <br /> p <br /> Property Owner's Name:P✓14� �p„eGa.rci. -" _ I� <br /> , o <br /> Property Owner's Mailing Address:4`1(3 ge.-c/-S - /Uti a�s �1�e,A )A/ 55\+Z n \ • <br /> ss __ n/� City State Zip w <br /> Property Site Address:3�Z4tO 15 -f fVG '13o.4`,btA.ry/ LL)z .SLI 3d . o <br /> 64 i (7 S -7Ys© — <br /> Contact's Telephone Number: W <br /> O <br /> Contact's Email: -7 o..CG 4)a"6. 9.203 may. C - 60t"'\ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .t, <br /> legible and your email provider will accept mails from the following address: t�BurncttCountyWI.gov o "' <br /> Legal Description of PropertyLQ4- ( C 42Li tbL 30 t 711 FcC ordkl .,>; .y lC1 r <br /> '4 � <br /> q <br /> Section it: Z 7 Town II: CI I N Range II: 1(o W Town of: 7‘,-)• 15 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* in <br /> X) - <br /> Tax ID Il(I 5 digit number; found on tax statement): S IC( LUQ 23_$'3 N n <br /> Proposed Use of Structure/Addition: t•'+^t'Sr. e/,'7'l''5 Pa„I•o0`SLn,.� Ro Zp,r404, �"'"` feet,,,,,, <br /> Anticipated Start Date: (llnnre/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: `'' /ti_2(^/"'u' Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rr 7 NA 1/4.r1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: - V' <br /> Q7--/ i5 a one -ye-ar exle44sion o-F G UP- Z 3 -533, < ..._, <br /> �a� P f /r 400 e-x p' -5 oil 06 ZozS, <br /> Fee Rec:I C0� <br /> 5. Check II: 61)3_7 <br /> x <br /> Date of staff site visit: 9 fi 9/ZO ZY Initials of site visit staff: i/' ® 11111 <br /> �, 'o. g-) <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /0//7eZy C ( -4 1 - <br /> - 0 .... <br /> ;uuu <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF o c ;„ 1 o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page I of 5 '�° 1----73 <br /> Burnett County, WI Land Use Application — Rev 04/2024 <br />