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. ' LAND USE PERMIT APPLICATION —Burnett County, WI a-a-a � <br /> ; i 0 <br /> Applicant Complete All Sections Below This Line 6' c �' <br /> Permit Types and Fees:Mlease,check appropriate boxes) � O <br /> ty <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200c--- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c•P p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CfQ\ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 `) p�� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r \\ <br /> w � <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 11 - <br /> *Communication Towers,Comping Permits&Signs require a different application form;see corresponding application,and fees. n 1� <br /> t. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ° <br /> Z <br /> o <br /> Property Owner's Name: b g r S�h, c�Y �6 0 '� <br /> Property Owner's Mailing Address:35 �'g Se c\c•l C> CA—, V 1 he c (-th MI SC(1) 1 cn <br /> _ City State Zip <br /> Property Site Address: ei t-,_?1-f GY\teJ /Gs J .'1 C"e(1 (1-) I S 4/$1� o <br /> q _ r <br /> rt <br /> Contact's Telephone Number: (Si—S cj ' . /S _,..... <br /> Na <br /> Contact's Email: ct c�,-eek-S @ CrM.%t r cQ.vv, <br /> **If staff has a question about this application,y will be contacted via email. Make sure your email address is N, .v <br /> aq <br /> legible and your email provider will accept emails from the followin addresses: @BurnettCounty.org and =. <br /> @BurnettCountyWI.gov <br /> �� G/ 5 v, ac Py, 066 Cfq <br /> P <br /> Legal Description of Property: n Y IS P 3- b <br /> r <br /> Section# t Town#: 3% N Range#: )i W Town of: 11an,QKS 4,0 �►'ck, <br /> *Attach additional page if needed Jro lengthy description OR attach a copy of the deed OR attach tax system proptrty page.* N <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addi ion: Pe I-Q b O►iC ,r -Cc,►^ � .- 1c\ S"v6m��- 9e'? W \A <br /> Anticipated Start Date:ICI j /,:z) L( (Home/Ca Com,nercia Business;Bedroom;Deck;etc.) pR <br /> Building Contractor:‹1-,evv\qh Pvt�..,y\ Sewer Installer: NA 7 w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z 1. v <br /> THIS PERMIT IS-SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 /vojL 6e_ a 5e 4r A U w,Qvt A44/7 z1/74, <br /> 0 <br /> Fee Rec: •e-- <br /> 5 Check#: <br /> m <br /> r <br /> 8 <br /> Date of staff site visit: /D7.17.040Z51 Initia of site visi taff: X r <br /> /Z / r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: = M <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF g F m <br /> o CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' -0 co o <br /> Page l of 5 - <br /> Burnett County, WI Land Use Application—Rev 5/2023 i nil <br /> (� _) <br />