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LAND USE PERMIT APPLICATION —Burnett County, WI E 0 <br /> Applicant Complete All Sections Below This Line o c w <br /> Pp P a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> S., Dwelling/Principal Structure 3 Addition/Alteration to Dwelling/Principal Structure $200 <br /> 01 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 •-,��j i <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 4 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c N. <br /> k` <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g <br /> 'NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ al <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. n t- I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o`''�1 V1' <br /> Y <br /> Property Owner's Name: '"Y-� R� V t''1'e� Q �Y1G �v <br /> �[ l�.CO-3 ma �' <br /> Property Owner's Mailing Address: ZSO-r'i t(Imo v"C. S . Y w.oke�(�'�15 ck kl b� 5`a`-41 e �,4. <br /> CityState Zin t1n <br /> Property Site Address: lI Q 7 ^O�J Z Z.' I -1,5 "19—S 'y `t oZ 4} 0d o k <br /> Contact's Telephone Number: CQ a - -3(Ct - 91 y1CV J 1` rke_, averftre- <br /> -t t, n <br /> c �y <br /> Contact's Email: nay)C.�i(/ _l/){} .7- C� lD ---ol ( 'cc <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is -,0 1 ,legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and i en <br /> @BurnettCountyWI.gov 00 <br /> �05r- k—vis L..c�-- 14- u3 . <br /> Legal Description of Property: I <br /> Section#: 1 i Town#: 41 N Range#: .R15 W Town of: ' ..J•D 65 v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* —0 3 lu <br /> Tax ID#(1-5 digit number;found on tax statement): ZZ7O V\ <br /> Proposed Use of Structure/Ad ition. (vi <br /> Anticipated Start Date: fal 1 Z.0 TO (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .L %01 <br /> •V <br /> Building Contractor: ` i.C 'C- COY1S+VVC_IIOV\. Sewer Installer: '-11-1'-•t1. - <br /> z ,h <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a, v 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> mee4- all �-b4Ck L <br /> s <br /> :,3• no l_ ivekc-c 3 bj ..50 ?-3 -175 <br /> el, WeiAic►,nc� �'yt coth?eef o�ol, h�ti la�C _ <br /> eti):: <br /> Fee Rec <br /> 6 o Check#: ( <br /> rn <br /> 9 <br /> V. <br /> 0 <br /> MI <br /> W <br /> Date of staff site visit: i 0/3 k3 I 'dais f sit vi 't staff: < ' <br /> APPROVED BY LAND SERVICES OFFICIAL. �-c� DATE: i(Pl/g3 Cl, I- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o < C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o , , <br /> Pagelof5 ,ov - <br /> Burnett County,WI Land Use Application-Rev 5/2023 n `" <br /> a <br /> .. �` �� <br /> 1 <br />