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DocuSign Envelope ID:0A3D047A-A6C9-45BC-B2CD-EB7D6B895231 <br /> LAND USE PERMIT APPLICATION -Burnett County, WI <br /> Applicant Complete All Sections Below This Line 3' et1 <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) F e , <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o (7 <br /> Filling/Grading $150 Boathouse $500 t- (U(��``_`l L <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. = <br /> *Communication Towers&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. rD <br /> r 9 <br /> 0 <br /> Property Owner's Name: Curtis Meyer o t <br /> -n t <br /> Property Owner's Mailing Address: 23077 Shuttleworth Rd, Siren, WI, 54872 °o <br /> City State Zip - <br /> Property Site Address: 23077 Shuttleworth Rd, Siren, WI, 54872 <br /> Contact's Telephone Number: (715)491-1173 "-491 <br /> N <br /> c <br /> Contact's Email: cmeyer@abc-cic.com o <br /> v <br /> a <br /> Legal Description of Property: SW NE (SUBJ/ESMT#411141) <br /> N ^0 <br /> Section#: 29 Town#: 38 N Range#: 17 W Town of: Daniels 2 °G <br /> o� <br /> *Attach additional page if needed,for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): 2686 <br /> Proposed Use of Structure/Addition: PV Solar System (35 panels, 1 inverter, 12.775 KW-DC) 200ABus/ v) <br /> Anticipated Start Date: 5/1/22 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.)200A Main MP o ,7 <br /> x <br /> = d <br /> Building Contractor: DC-111901088 Solcius LLC Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Iii 6. <br /> **The applicant needs to contact their('DC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z1 . <br /> horn dditions, and Bunk/souses.*; , I <br /> Ale AR G,11,f�•,',"�c s <br /> 0 <br /> sr 5 4464141 ��,: s, �,: e i- So k�b�4s <br /> ref. c.. fe14415.c-4., 4.4iz Fee Rec: /5O <br /> Check#: /9? D <br /> s/1�1�� tit'Date of staff site visit: Initials of site visit s aff a <br /> //qa. m C:-.1 <br /> cr <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: g DATE: 5&(7( 7 x <br /> N <br /> UPON APPROVAL: APPLICANT ST POST COPY OF z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> Transcendent: Page 1 of 4crl .$ C_ r'� C <br /> Burnett County, WI Land Use Application —Rev 12/2020 < ='` <br /> Laserfische: - a� W <br /> Ct <br /> cn <br /> a it <br />