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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o I i <br /> Vit <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> r Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures o <br /> y pg $125 WI State Statute 59.692(ly)Structures $350 ,.,� <br /> Filling/Grading $150 Boathouse $500 V <br /> v) <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 tothree times the normal fee. `2 <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. b.t\A fir <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o , <br /> Property Owner's Name: 1C,.^\�_ 4-A.-) c L1e i .W:. o w 1 <br /> Property Owner's Mailing Address cox\NV=I_ li- ',--; 0`, C,c-t'C�CN SS}A. . n <br /> _ City State Zip vl Qs() <br /> Property Site Address: S� Can- �S:�c� Nc- o <br /> Contact's Telephone Number: `C�-S \— - . Cl .)(---„, °' <br /> Contact's Email: CS"-,. ._AS '-, % C.( `=- ` crC:-, \ L- s�---, � <br /> **If staff has a question about this li ti ,you will be 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 °Q <br /> @BurnettCountyWI.gov i ai <br /> \I\Legal Description of Property: G . <br /> Section#:*1SG Town#:‘-'‘ N Range#: \S W Town of: (: p ':- . u) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* A <br /> A ° - <br /> Tax ID#(1-5 digit number;found on tax statement): Cc, \ 1 I <br /> Proposed Use of Structur�A dition_C .c \.V •r K� ` 'v\\\A C\ t -1 <br /> Anticipated Start Date: (Home/Cabin; mercial Business;Bedro m;Deck;etc.) 1 <br /> Building Contractor: \L2 a ; >� Sewer Installer: \\3 n' - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I o o all Coi't �� ©�S m VnA-2 3 - Z1. <br /> 6CAmAci-- U4G- ' -;,t /9e-C--74es 710 5C'P. ill /41ey eepu/(4"e-- Cl <br /> � to <br /> (1-- <br /> to �lM 1 1--; /_ x Fee Rec: v p <br /> l h°� l p v� !� -�/�dt/IS P�' S��- 3-I 70, o Check#: `� C! / <br /> 6 d wei�!1�y '7' �1� m <br /> z <br /> ti <br /> C J l <br /> rf <br /> Date of staff site visit: 8 85/Q�3 Ini 'als f site visit staff: �E-_ x�47 ? <br /> r <br /> V I <br /> can 07 <br /> IMI <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: g C,7 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF - � Inn] <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT El za.-- `�h ., <br /> Page l of 5 2 UUiJ <br /> Burnett County, WI Land Use Application-Rev 3/2023 . JJ <br /> a <br />