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LAND USE PERMIT APPLICATION — Burnett County, WI a i <br /> , <br /> . • Applicant Complete All Sections Below This Line a c w <br /> Permit Types and Fees:(Please,check appropriate boxes) ca. <br /> W <br /> Dwelling/Principal Structure $300 i Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 5' FD <br /> C�Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \ z <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° St.) <br /> ch <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 (1 <br /> Filling/Grading $150 Boathouse $500 r —7 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE: After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. Ci- <br /> ro <br /> r -÷ <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' "' <br /> gr 1 z <br /> Property Owner's Name: ' d 7 ��,-.� 1 =' ° <br /> Property Owner's Mailing Address: 7 / s L l?O✓� -t �`' �'��� VGI�/b(ts, 4 CE�1 SVS n C--C <br /> '. 9 City State Zip `" <br /> Property Site Address: S 7 7.5.Le dim LLke_ f d{,l 0 '► xcy, u/s 5 y.S�s.'C2 < <br /> `�] L� c, /�,/ fY L�^ •o <br /> Contact's Telephone Number: / Jd J '1 / - c2 J a v, <br /> Contact's Email: PC .. 17i C-4(Ct'-l.`' r e)..9 a r�l, C C"- e t <br /> **If staff has a question/ about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °O <br /> @BurnettCountyWi.gov w <br /> PC- FRL it (L-ot In D -00-) <br /> Legal Description of Property: ff. <br /> Section#: 0.1 Town#: / D N Range#: - S W Town of: J a C is C/'-1 c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* - d <br /> , Ip 9 <br /> Tax ID#(1-5 digit number; found on tax statement): ', 7 Li 0 ,1 i$c r€+r;/1 ed H d <br /> ) <br /> Proposed Use of Structure/Addition: C 0 Lt t' CC 01-e C k L£,7,'f i ( i.M p az C e S 5 <br /> Anticipated Start Date: 7•_/O-,., C, 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) s <br /> rrA 0 0 <br /> Building Contractor: SC'I T Sewer Installer: r A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> - Mee,-1- cat se-backs <r <br /> luttA ct.0 Cu,rrUt+ W1h --0-u e se-P-I-i c St- L JS �,.��' <br /> x Fee Rec: �c-t�� <br /> o Check#: II Q <br /> m <br /> z <br /> II__ v <br /> ra <br /> Date of staff site visit: l0 l2ct/1023 Initi is of site visit staff: KT ` <br /> y N <br /> APPROVED BY LAND SERVICES OFFICIAL: U DATE: Al Z� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <3 Z 0 <br /> z . m <br /> y » N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 0 0 N <br /> Page l of 5 < � � r <br /> Burnett County, WI Land Use Application—Rev 3/2023 CAI <br /> 0 s <br /> a <br />