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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line 0 CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> C7 <br /> Dwelling/Principal Structure $300 X 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 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk •Bunkhouse $250 ° N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 —r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P. r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three 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. <br /> z <br /> 0 <br /> Property Owner's Name: 5c.eo f7`ticc'et Pr f CSC I o N N <br /> Property Owner's Mailing Address: �' S ? / S c 5 t w Y r 0 0a,Q1,4( OLT Sy7.34, c, (� �' <br /> City State Zip _L. � <br /> Property Site Address: p7 0 I? /V R t c e L.Gt k Ra o N <br /> • c <br /> Contact's Telephone Number: 7/ S &7 Q o/ 3 3 a <br /> Contact's Email: P r S s cis a 7 aNk eo < cLevii <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °c °O W <br /> [-.I S' _ <br /> Legal Description of Property: o 0. -D <br /> Section#: (O Town#: '39 N Range#: 1 Li W Town of: R LLS <br /> 0' 1J <br /> LA <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �0 <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): I S 7 5-3 Q <br /> d <br /> Proposed Use of Structure/Addition: .J-/Lt C(D S Q 11p S 7 u i r' eel St 5:'cl e c 4-' C a b i -3 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W <br /> 0 .2 <br /> Building Contractor: AI X S e(42 Sewer Installer: y <br /> cn <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z 11`� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> bah+ oll� �,-('(UGIc,�S m ._ <br /> O DvvQ,Q�ilfl np+ 40 tI ctcct2 10€C)fCX 1S S'OM 122544 a Fee Rec:At <br /> [202'4 <br /> z Check#:3�J�9 <br /> O Lock DI.d ciAo:A r hQ..e kcl on stio-H c -Eun k lid bq( u It <br /> 01 <br /> Date of staff site visit: JI/Z 12-OZ I Init'als of site visit staff: rr lit o r <br /> Lrltnnil <br /> APPROVED BY LAND SERVICES OFFICIAL _ ) MDATE: -7 6 �Z l 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF mIra <br /> N 0 <br /> CI C <br /> coN <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> Iriril <br /> Pagelof5 R. <br /> Burnett County, WI Land Use Application—Rev 12/2023 Lc--)J <br />