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LAND USE PERMIT APPLICATION - Burnett County, WI - " <br /> s b <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and Fees'Please,check appropriate boxes) ca. <br /> C7 <br /> /Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> 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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 19 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. �, <br /> z <br /> P <br /> Property Owner's Name:�p.,1(� Q, p� yl �,�/` o , <br /> Property Owner's Mailing Address: 1 0 10 S A-. G c o-t ii-S I r i W r?o'* � v <br /> Sta <br /> Property Site Address: 4264‘ C..Gh,pLS e fir f vgf. I.dlytdelq.ef e < <br /> � <br /> Contact's Telephone Number: 6951 - c Cl-- ( 3 z 9 s 3 \ ^ a <br /> N p <br /> Contact's Email: Ck G4 6-01 (0g /keOr ► CAD VA' ;° <br /> **If staff has a question abodt this application,you will be contacted via email. Make sure your email address is N ,a <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° °Q <br /> @BurnettCountyWl.gov A. <br /> s�-/Vw ,7//Ha, YOQsZ <br /> 0. <br /> Legal Description of Property: Y 0. <br /> Section#: 9 Town#: 31 N Range#: ) 7 W Town of: if...1 h c a` v.. En <br /> I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ......0 f <br /> Tax ID#(1-5 digit number;found on tax statement): /0 `c 5 d <br /> Proposed Use of Structure/Addition: 40 "Q., <br /> Anticipated Start Date: l t-16- - ZPa 3 (Home/Cabin;Commercial Business;Bedroom;Deck;c! etc.) <br /> Building Contractor: Sewer Installer: HWDii�/YI 5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z s <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 0 ro//et,3 cif/ F//fd e a f(a/rt 1ter u,.r1i^P en ?Ls, s ce. a 717' e. e c/ <br /> Z-o f'"t/,L a A d o r 1- tci-b 1� Ud/u ey �y`4 Pt C , �/ / <br /> el S u b)N1l'/ el000"1 m C c Y''J{"T`c 97"1D!/1 Q'Fj e-r- OLIO' or'74 ce,US/itif�7` ; 1a ,� <br /> x Fee Re 300 <br /> gS a to l'1c r y vec CI rn In ec 7— �f'P 2 V-/O. v �ieelr#r CaSk <br /> a C / vD& l�5 fe tr' //' y7i(�11^ ,Deis A/71; <br /> z <br /> rri r <br /> Date of staff site visit: ..5/ 20-eO Initials of site visit staff: K T x a <br /> y �W O {jul <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: OSA,Z a c m a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 2 z- 0 trul <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w C< <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 JJ <br /> a <br /> 3 <br />