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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(Please,check appropriate boxes) a <br /> m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :o kll <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 Z cD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G� N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 (D <br /> Solar Panels(Stand alone or roof mounted) $150 N Permit Extension(1 Year Extension-Allowed Once) $100 ,� E ' <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. c, <br /> n <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 /> z k <br /> P II <br /> Property Owner's Name: 3ei4"I ;' V(..7d ej Sef- o �� <br /> Property Owner's Mailing Address: ) 7 y/u,O CA/-es'j j 2 C e_et ICt c.d F. n p <br /> City State Zi ° ci <br /> Property Site Address: )ill ,Q (pi, Cyr ai-S 40-)e_r e j We k r (Ali cc/eV' o y <br /> Contact's Telephone Number: 1/S—, -4o)-- `j G i6_S" b a <br /> i d <br /> p <br /> Contact's Email: 9 e d e P 14 j .i1 1-S C '7'/4. Hod, c 'N^ W ' <br /> **If staff has a question about this application,you willbe 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 cm' <br /> @BurnettCountyWI.gov i _ <br /> Legal Description of Property:PC_L l�ov LOTS q 4.5 DDSG '6o7/531 EX CSM V 2_2 P1F °9 <br /> /Section#: 25 Town#: o N Range#: 1(p W Town of: V Qdkja,tc <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W o H <br /> 2 i) ° d <br /> Tax ID#(1-5 digit number;found on tax statement): 3 2.01 I <br /> cA(q -e- P .4- & ,eN�`Cry H W <br /> Proposed Use of Structure/Addition: �j � �,� ✓►1� i F N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) CY <br /> b <br /> Building Contractor: Sewer Installer: Cor`1- : )4.5"vet, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • IV(R,-} cal s-e..-4-10cv,.-.5 <br /> n YJ;- ` a <br /> • Nod h��+�won <br /> i - <br /> ? Fee Rec: <br /> v Check#: <br /> m <br /> o• I <br /> Date of staff site visit: L W Initials of site visit staffF. < , ffil <br /> U/''` �INZ� m .0 <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: < ? r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD <br /> zoo <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> iw <br /> Page 1of5 In = i <br /> Burnett County, WI Land Use Application—Rev 3/2023 R L` JJ! <br /> a <br />