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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c w <br /> P. <br /> Permit Types and Fees(Please,check appropriate boxes) C7 j..j <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° l' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o P , <br /> r <br /> Filling/Grading $150 Boathouse $500 w N <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 At- 2. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ^� '7 <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' ' <br /> z <br /> iii <br /> Property Owner's Name: cekoYZ-vvnaxn n c W <br /> Property Owner's Mailing Address: 5S2 Lirldt+-*. Una_ Ci rt+ L o- r ow cc)/ v d <br /> City State Zip "' 6, <br /> 1-3 <br /> Property Site Address: Z 73 OZ- H1 I( led 6-4 CrertsA-mo <br /> (Ai 1 o/ o N <br /> c <br /> a <br /> Contact's Telephone Number: (.42- L.-70 - S`7o 514 1 d <br /> Contact's Email: hie►')dy SS'Z @ C cr-r,-,c-..t.4, 'Id-- <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N C <br /> I. <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and 4) <br /> @BurnettCountyWl.gov i <br /> Legal Description of Property: C a'�" ? C. S'h'1 V 8' 1°2-S 3 `i. rv(I\ <br /> Section#: 3 (.o Town#: IVO N Range#: / L7I W Town of: co silLt- <br /> ,e ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): I% 2-- <br /> Proposed Use of Structure/Addition: 7 S-ei.S r-,,-, ed rd, U n ALI- 04e 41(-- (� �J <br /> Anticipated Start Date: J u b' ) t 7....4:3Z3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> � <br /> M <br /> Building Contractor: Sewer Installer: w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (heeA- . .I I s c 3 <br /> V N4�- i 4 c vcas e- Di;it+ o4 Dec. n <br /> tr �lir, 4of` iv e)(C€., 3 (XGf� pef .54N4P/ b �' Fee Rec: d <br /> c Check#: C 4- <br /> z <br /> v <br /> //^^�� U m <br /> Date of staff site visit:5'3 ' ! d Initials f site vi ' staff: IN/ < �r <br /> m = <br /> a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 11 <br /> a CO CO <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ a <br /> Pagelof5 B w <br /> Burnett County, WI Land Use Application-Rev 3/2023 0 <br /> cn <br /> L. J <br /> 3 <br />