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LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> a <br /> Applicant Complete All Sections Below This Line 0 cn• w <br /> D I <br /> Permit T s and Fees Please check a n <br /> ype ppropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 6 <br /> /Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> / O <br /> ' Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 L <br /> 0 <br /> o Pt <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g �* <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 2 e <br /> o r <br /> Property Owner's Name: C T r,kt / a- OA rid eZ'iV ic' -64 K / . T o <br /> o <br /> Property Owner's Mailing Address: - S y (.,ui L . ci t;e i icW S V i LL' mA, _cs- .icy, m n • <br /> City State Zip ° t <br /> Property Site Address: 9--.5-,?/ i,uJ,A//- ryN IA<.e. I . ,'e V .,1- 1 >7 clo <br /> a ii• <br /> Contact's Telephone Number: (4, I - •A7.A-f*�/i a ill <br /> ? <br /> Contact's Email: ._4'S/V A gfI,t6 Ler �Aa i t-, �oM c , <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,b j <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 00 I <br /> @BurnettCountyWl.gov <br /> 07-Dob-U)- i7-,,AV"...'-' as•CC)6- 451700C) d <br /> Legal Description of Property: S ,4/ i2v 38 R/7 ?Ct._ i Lc i L i <br /> Section#: A/ Town#: pcDL N Range#: W Town of: j. Ahit t'i_ c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p` o <br /> . t <br /> . 7 Tax ID#(1-5 digit number;found on tax statement): 4 9 &, <br /> '-I 9J <br /> Proposed Use of Structure/Addition: 4/-/C� - f1e fx.<r �Xtz7->Nd- ,ge) SPr(Y1z �('A i/OiV d ' - <br /> Anticipated Start Date: __-I Li I y c L' 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) T. <br /> Building Contractor: -JAc_(< KAze�. Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> nl'jee. - a.§ SDI-b4,& <br /> 0Na+- h .bt. .$ <br /> Fee Rec: /5(J- <br /> o Check#: ?5( J9 <br /> m <br /> tz <br /> Date of staff site visit: / B u <br /> 5la 3 Initi of site ' it staff: il'r x <br /> APPROVED BY LAND SERVICES OFFIC DATE:i3( ? 3 „,3 MI <br /> a ll u 11 <br /> v o ^' c=1 <br /> Pagelof7 4 •< o C4 <br /> Burnett County, WI Land Use Application-Rev 5/2023 < g. `. <br /> friiil <br /> ga <br /> L -_J) <br />