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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees(P/ease,check appropriate boxes) _ °' , <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \d <br /> Accessory Structure(Garage,Shed,etc.) $150 )( Addition/Alteration to Accessory Structure $150 = <br /> a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 .r� <br /> n 7CJ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' I <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. r a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree 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. <br /> z <br /> Property Owner's Name: R tc-act,.c-,?D Lei 1.1 Cy o •' <br /> o <br /> Property Owner's Mailing Address: Po 6 $G x , . ,tlu►?c�R�/ Got €5 y�{>G a <br /> City State Zip E <br /> Property Site Address: 3.0 S S C IZ F ) yatu3,r2,/ to S`-/33 0 c „.7.-' <br /> Contact's Telephone Number: (C5 ' ) 7 ? g' - 4 53 'Z-, n. <br /> Izz.... t7 <br /> Contact's Email: 1&u't ti1 - ©czkS I ( 6 Q Ito -fn a ; ( . cc, aL"\__ CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> nz <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and an j <br /> @BurnettCountyWI.gov ado <br /> d <br /> Legal Description of Property:.(v T Z CE,2i't Fri) (td-a 1/ 77 7 Z- Vo L /c' /3( -/ 3 7 �. ( � <br /> Accc 11 3'�75 7} W <br /> Section#: 75 Z Town#: '-( ( N Range#: '(, W Town of: j u), 55 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f <br /> Tax ID#(1-5 digit number;found on tax statement): 2 Z Z 4 _ d <br /> Proposed Use of Structure/Addition: Zrf .Dg/ 1 :,.;e2 t (4,,,,t! r.2,e,e.�. / STvR-a4£ y E v <br /> Anticipated Start Date: c.ip 1 �c`2 3 /(Home/Cabin;Commercial Busin ss;Bedroom;Deck;etc.) „C <br /> Building Contractor: i/ rb Qse��u .5> cr7c. ,,) Sewer Installer: 5 Td`l'�/ d U -' '- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT ISSUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> J f'le.e-I— Q,11 5 �c (s <br /> CP Nod- Aer 11/4/na n llir-r.S01 h �� / <br /> '3 �G1 4 &.0 ''\ IS /'�4C{ .Y` Gil. s T)c� <br /> ''' � Fee Rec: l-Q--- <br /> 4 '�c,-�o 1,-,.6e���- area/1 -c' be. rem or efi"1 U Piii).3 c Check#: l (Y3 <br /> P (/ m <br /> w,=r11;/1 7$4 Sic z <br /> alrA <br /> Date of staff site visit: 7/131a3 I iti is o site v' its )4,6 < <br /> ___:„_,,r__;:2) <br /> APPROVED BY LAND SERVICES OFFICIAL: �/ DATE:7// [ !d CA Ct. <br /> m a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF co <br /> °z m ` o Efft <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT `cri o° <br /> r <br /> Page 1 of 5 < w <br /> Burnett County, WI Land Use Application-Rev 3/2023 v a <br /> ml <br /> x <br /> -I) <br /> b <br />