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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> a b <br /> cn tJ <br /> Applicant Complete All Sections Below This Line 5. (A)Permit Types and Fees�Please,check appropriate boxes) CD I <br /> a <br /> Dwelling/Principal Structure $300 \ Addition/Alteration to Dwelling/Principal Structure K c. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/ndustrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory S ucture $1 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Bunkhouse $250 <br /> GC` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk �, � -- ' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o r-- <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 /> *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. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> i /' A z <br /> Property Owner's Name: J r k...� G- " ik , 'C <br /> 2 LII <br /> � A . <br /> Property Owner's Mailing Address: \53Q70 l�, t )J O > -�! J a( �` �`M-� In G) <br /> City State ip <br /> Property Site Address: ,. 9, \-\L,.0,-,� q 1 r 'A. & f i&&' <br /> Contact's Telephone Number:�i3 ' \-k 3 0 ' 3 C�1 g'S a <br /> n <br /> r <br /> Contact's Email: � v� � (�G- El'. (..^vl^�� (.�' * . Y - <br /> **If staff has a question about alication,you will be contacted via email. Make sure your email address is N ,ti <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 8. °O <br /> @BurnettCountyWI.gov °° <br /> d <br /> Legal Description of Property:\\An S� n 1A^ h \ i ,A <br /> Section#: 34 Town#: ,3 8 N Range#: 1 S W Town of: wood ,Ve-,/ cmv' <br /> *Attach additional page if needed for lengthy description OR attach a copy ofthe deed OR attach tax system property page.* ?A 1 F <br /> Tax ID#(1-5 digit number;found on tax statement): a t coJ o <br /> $ �.J <br /> Proposed Use of Structure/ 1dition: Gam--.-il <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) l f <br /> 0 <br /> Building Contractor: Sewer Installer: C. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTEDBELOW: <br /> 0 :5 RAJ:46/i w _!as : , . 54l 1 e -�ODTr;'.4- 0-c- <br /> pra,11,,,, Aa4- �v odc4 oP- be r 5 T"eC SigN- 4 S3 ( _/ L ADr �or - Fee Rec: O <br /> ��JJ 0.5 G, is50 `/,4Iv o Check#: E <br /> O %reltti '7 (1'ee.S 4 a' <br /> A/j VIG 6,*R�*A);c wool, Jt2 use As y <br /> h p cif/nit, �/ 5/cc f ' cp u gt4c 5 5 c.�n ' 4ke lisfi'" ' d <br /> Date of staff site visit: L)/11/93 Initials f site vis' staff: I-1 r✓ n (:=7 <br /> APPROVED BY LAND SERVICES OFFICIAL: �C.Y. DATE: Liii o?/ ?-3 m -5 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 3 M n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> N <br /> Pagelof5 w c <br /> Burnett County, WI Land Use Application-Rev 12/2022 a Uirl <br /> x <br />