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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c A <br /> PP P , <br /> Permit Types and Fees(Please,check appropriate boxes) O �? <br /> KroDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 h <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 $' .) 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? i <br /> w , <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. q <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> �I z <br /> Property Owner's Name: ' a C f tic o N <br /> / " <br /> 0. <br /> Property Owner's Mailing Address: 3 6 CO.a 6, nit s `k( -(;,00 jyylf 5c".0120 =r. n C- <br /> Z6325 City State Zip E 00 <br /> Property Site Address: T{ld/a,i;) fillittiA Rdi S,baDY1lPr LT /(0) o <br /> Contact's Telephone Number: 7 63 ',p,576 4c 4 <br /> b <br /> G.Contact's Email: CIC eery^ y 9� h i 1 vl/1 d)1-1**If staff has a question aboutthis application,you will be contacted via email. Make sure your email address is N -� <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °Q tv <br /> (31 <br /> Legal Description of Property: See IS- Tr,3-1 ,n 9 i V fC��11, �U Q r� N <br /> Section#: / 5- Town#: 3 9 N Range#: /y W Town of: R(4 SA- N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cr 1/1/4) <br /> 0-3 <br /> Tax ID#(1-5 digit number;found on tax statement): / 9g 7 N 3 5 <br /> Proposed Use of Structure/Addition: Ca,JJ iv -I ? --- <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> a <br /> x <br /> Building Contractor: Sewer Installer: (A i� g i,ii"c i\p/ ),% l''' .fr)7' .--'t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 8 m <br /> CARA- au 34,4-locu,k-s „, <br /> Fi <br /> l�Wakin, exce d bescros S N - 23 -(�8' ��_ <br /> MFee Rec: <br /> ID CAlC1 O �I� om D�tt�1uy cat (,up(' lnsp-kY, O(1 yU�„k -scyi 55�1-2 05 ,° Check#: .Zs ,4 <br /> �15- 3 , <br /> -b .ensue 19,4;4.4 n5 is ,(ii171 code -car 0;4rA-b►lt t <br /> J <br /> Date of staff site visit: I I I p 110-4 Initials of site visit staff: T. c 1 <br /> pp " <br /> ^ <br /> Fill <br /> /g/2o21 APPROVED BY LAND SERVICES OFFICIAL DATE: m so 7''" 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o _ <br /> CI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> UvU <br /> Page 1 of 5 �� JJ <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />