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LAND USE PERMIT APPLICATION — Burnett County, WI k 3 <br /> m N <br /> Applicant Complete MI Sections Below This Line 0 '.'0 <br /> Permit Types and Fees'Please,check appropriate boxes) " <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure 5200 ' j 2. J <br /> I Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> — f! q\\ <br /> i Accessory Structure(Garage,Shed,etc.) $150 ,Addition/Alteration to Accessory Structure -- $190 j ' 1 _.1 <br /> `Accessory Structure(Commercial/Industrial)$200 Addition/Alteration to Bunkhouse $SSO I y et.'l <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk <br /> Bunkhouse $250 j ‹,-.1. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures 5350 1 CO'— — <br /> _^Filling/Grading $150 Boathouse $500 { , 01 ; <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 m C7 <br /> I4. 'NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. F- <br /> , •Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1 j^ a <br /> i <br /> 'items not listed above will be treated os accessory structures,such as:pergolas,landscaping etc. a z �� <br /> o <br /> Property Owner's Name:_r 1��4 - S‘,tifl*)&1� O I Z trr�C o T'R luo�[ — IQ t <br /> b a� CAC AMUS ctA.C(Q rrnF 70 et <br /> n R p <br /> Property Owner's Mailing>Address: �V N �S3 <br /> E 4N 0 <br /> City State Zip E -� N <br /> Property Site Address: a VI y O I)Q r t..‘►IS o,- A Grit D bA44b tA lI C4 u. I 5Y P3 O I y <br /> t . <br /> Contact's Telephone Number (p( '- .51 "Cc V 3 0 e- -(p b ,- s i a' <br /> ,, fp l �135 d ,-1- e, <br /> ,a <br /> y' Contact's Email:__Y ,�vI Et 1 Sn�® (.?d 1 I•C n t�f� VI60�R crld 4 Ctii. ` 0 =, s <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email eMis „/ ,� `� --� <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and wr• „ <br /> @BumettCountyWl.gov S e C 1.3 TV 4 0 'fiq 1 10 t.cr9 l d -t. o (,_ N en <br /> Legal Description of Property:_ C 4 y1'1 V 1 It P 133 el. (.a1 3 (7 D 18 a�V l uT3) �. 'W -f- <br /> Section#: pl3 Town#: �1() N Range#: �o W Town of: i-vl'S 1d-a SrY‘ V t d I� I( 6` <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach s, em pr erty� age.r 1 ,; <br /> I 1V 1Tax ID#(1-5 digit number;found on tax statement): 3 L 3 9}O V 11 l�l C v ` 1J 1 W <br /> • <br /> Proposed Use of Structure/Add'tion: 1E.$0 -r 0 Co C 00 c e f 6A-r9 �, Q <br /> Anticipated Start Date: 3/ 2()Z' — (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) %,..t W <br /> Building Contractor: K i41( J IS Sewer Installer: _ E 0 ...LT <br /> ' AREA BELOW THIS LINE FOR LAND?SERVICES STAFF COMMENTS/CONDITIONS ONLY z G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� <br /> - I\t- -for hu.m a..v1 tab►-}-�-k-i or <br /> -L j Comb) O'c ,1 i, i44\ o Ce,r-E.-€+e.d 5, �{ T&o f bq 2o21 <br /> Q Fee Rec: 3060- <br /> - as -'ion clo s fo+- -e x,ce e d 5010 rib IOW lain, -CAVC-t -kr <br /> �h't-1 c c�r�orrn t tit (€O l D+' e ) ` Check#:_�„ <br /> non- (,vr -C-Off l,;r� S re S (ADA-C t o <br /> a <br /> /2.02.3 0 CD <br /> Date of staff site visit: 4 12.1 I it Is of site visit aff: k• i <br /> APPROVED BY LAND SERVICES OFFICI ATE: /2q/4Z 3 m m m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z y : r. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` �`F <br /> w c C1 <br /> Page 1 of 5 Ti w m <br /> Burnett County, WI Land Use Application—Rev 12/2022 g g <br /> › L ) <br /> i <br />