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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 7 rn C te <br /> Permit Types and Fees4'Please,check appropriate boxes)'., C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 P <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> �f p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> `U3 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° O ` <br /> AMTiveway0'&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> o I <br /> Filling/Grading $150 Boathouse $500 AI <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. I <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ; <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> i ' o <br /> (_�Property Owner's Name: i �ollG�.tv t-t��Se <br /> 20 2 4 \7 EA ` r veu b-5330 . <br /> Property Owner's Mailing Address: ` -1 M►l F. <br /> City State Zip cp <br /> Property Site Address: 2 9 *l 0r L c k r✓ 1 1,t,�eb 5te-r �i tSc < <br /> .. _ <br /> Contact's Telephone Number: 14'3 - 2.L I—. e 39 r� 1 d t 1 <br /> Contact's Email: C�D t\ r\ 1'Y\ b •-ici_ � , �'r`�1 /de <br /> **If staff has a question about this application, you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and S Erg <br /> @BurnettCountyWl.gov o N <br /> Legal Description of Property: Se` 2-1 Tr, LAc; (Z., 14- L.- Z Cf ti \I 1$ P 29 011Ga8'1v) 5. <br /> 9 <br /> Section#: Zel Town#: 4(3 N Range#: (4- ��o- k <br /> W Town of: <br /> CA <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* /V n` o H <br /> '� = 6 <br /> Tax ID#(1-5 digit number;found on tax statement): t (053 I rr <br /> 1 <br /> Proposed Use of Structure/Addition: d r t V eW("1-k i I � -- <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) l, <br /> Building Contractor: Sewer Installer: —ro Pk0-\ Sc,A,k i. 6v^ckv< k Ocl <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY _. <br /> 0�THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> / tt G✓IM/'7L / 0441i1i' e • c4 ' p7, <br /> Cry(Ad- lt_ Tw of 7Lo sew /7Caliy ,"-c38' id- <br /> +/_ x Fee Rec: <br /> f e.Ar lM l . r1 yam_ )/r�q(�i/j/'e� l..l jeiwl , o Check#: . - <br /> r 1., �Airmeruanemos <br /> y -drs.a Mil�srr-.-4 <br /> d CD <br /> Date of staff site visit: L/13 Ini ' ]s o to vi ' lie ,i,< oHi <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: -S/3 0 Ze22'3 m F,ca D <br /> -3 <_= -< <br /> > 0m <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF o 0• 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,• w w C <br /> CD M <br /> Page l of 5 It <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 L...... JJ <br /> -I <br /> D <br /> 'v <br />