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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line cn CD w <br /> Permit Types and Fees(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 , --9 Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 5' <br /> F Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 g) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c W, <br /> Filling/Grading $150 Boathouse $500 <br /> r <br /> Solar Panels(Stand alone or roof mounted) $150 (Permit Extension(1 Year Extension-Allowed Once) $100 6 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. $ <br /> ro <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. a <br /> f�. f o c_' <br /> Property Owner's Name: /CRt / /L i' / .Ti <br /> i �'' ` o <br /> 0. <br /> Property Owner's Mailing Address:c35-g0 . ASCT. /,�(/ g ray7ks j9i cs 6.422---SWV I <br /> City State Zip <br /> 4 ' <br /> Property Site Address: (same_ c s u Ae)II 9 o N <br /> Contact's Telephone Number: 7x.5 -G _7--,2 S 1.... a a <br /> d <br /> •Contact's Email: 1�cxre rt. lJio r. )14 va i , i C/v c.td. CO 01 - <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o 0,:,@BurnettCountyWl.gov a'o <br /> 197R �F �- 17 PC) re Alto <br /> Legal Description of Property: �e G. 3. <br /> Section#: /9 Town#: ,3R N Range#: J 7 W Town of: AA tie) .23 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ,--) o H <br /> Tax ID#(1-5 digit number;found on tax statement): &3 7 f CI <br /> Proposed Use of Structure/Addition: ee—C-Alc J <br /> Anticipated Start Date: -.)tiofdF„r (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ------- <br /> Building Contractor: t1. Sewer Installer: <br /> QJ�iq f�; 'r�r <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z ,., <br /> Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 iThee4-- G ll setjc,c, s, <br /> x FeeRec:�5"42 <br /> tz <br /> v Check#: _. <br /> m <br /> z <br /> I u�i tA <br /> v <br /> Date of staff site visit: 9/3h----3 Initi is of site isit staff: f I <br /> APPROVED BY LAND SERVICES OFFICIAL:9 ( T6GC, DATE: P-3 r, a Iffl <br /> > cf,w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z = 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o ,� W� <br /> Page 1 of 5 3`` INa <br /> Burnett County, WI Land Use Application—Rev 3/2023 CD <br /> = 7 u h h- <br />