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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line * w <br /> Permit Types and Fees:(Please,check appropriate boxes) a CIJ <br /> d (lC/ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 00 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 4) i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r° �. <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 +c) _ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <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. S ' <br /> p <br /> Property Owner's Name: 3;(tp"- 4- -11441,Ch- c,r(rt, - 0 <br /> ! __� 5533 I- . - <br /> Property Owner's Mailing Address: ,5-OtO an 1 Ttrpc�_ S yjetel / Of $7D 1 �. n <br /> -T CityState Zip <br /> Property Site Address: 49 6�%0 (,off(4164.1 l rF4t(u✓A -1 o r <br /> Contact's Telephone Number: (o(a•3CO�- 7G 't 1 r 40r' S p <br /> 5 e i( T'G-- cD <br /> -DaContact's Email: ( v 5 — brl-(AAA_e 4t..24--wt.� ,eois 7/�NK faJ3Si'co f#I t� Calk°c ov t <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N - <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °0 <br /> @BurnettCounty W 1.gov rro <br /> Legal Description of Property: aprcx,. 1 2,SeEf-cvi. �T{ l fie,/17,' S C.wJ 5 <br /> Section#: /Li Town#: L/ 7 N Range#: Ilc- W Town of: =�� js�.-- <br /> cin <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ,� o <br /> Tax ID#(1-5 digit number;found on tax statement): S340-7 <br /> V1 <br /> Proposed Use of Structure/Addition: C -Z� .-- C <br /> Anticipated Start Date: TO (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor: 77Lfe (lcvt4-t`uC' Sewer Installer: erei i.nCt'f -644-ciir....-al-eztvoNCA <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS S BJECT TO ALL CONDITIONS LISTED BELOW: <br /> Mee+ ad( <br /> No, u✓ an - -kdi <br /> � h <br /> 3 1,.)65- S,I e r�.ee (4 be ►� ✓�9ek- R,61 se-fb� , _ jj�� <br /> w/tell vir :r Ore aOC se-fbjs x Fee Rec: (,) L)=' <br /> Check#: (,-) <br /> r- <br /> � JD <br /> m r- ""� <br /> Date of staff site visit: /1,512-, I i is of 'te it staff: ,)-I < QNO <br /> 6//q/2-� m coca ,a 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: < 3 Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o y -0 � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` w <br /> c< <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 3/2023 d (S.... JJ <br />