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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> Applicant Complete All Sections Below This Line 5 w <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) ._.. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ' <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 g L <br /> ■P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <<, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t lb <br /> Filling/Grading $150 Boathouse $500 r • <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P_ <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. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o =' w <br /> • <br /> Property Owner's Name: ,% -2 d I t -Cc C.-KS el <br /> o �n o r <br /> o <br /> Property Owner's Mailing Address: 7''7 ? LEA Po/ Webs-t ' 04 - 'I??3 7 <br /> , City State Zip ' 3 <br /> Property Site Address: � yI LF. Rd vv-8/�5,?-e--- l SY 3;3 0 <br /> r <br /> Contact's Telephone Number: 7/5. - '7 .3 3 �. <br /> - 0 C�S a <br /> d <br /> Contact's Email: Cf 3cic_ k Sc,Si COki Cv^e+e Q q yr-tic;t' • COV <br /> **If staff has a question about this application,you will be contact 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 S b0 <br /> @BurnettCountyWl.gov o .` <br /> d <br /> Legal Description of Property: ,27 417 7 L F k— ,- <br /> Section#: ,2(o Town#: Lib N Range#: /7 W Town of: arl/On E4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): <S C)c7 a d <br /> Proposed Use of Structure/ ddition: G(L ' — 54Orcl pec coo,( y <br /> Anticipated Start Date: " I- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: , notr.6,." --1 ci C KSmw, Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT IS SUBJE�T�TO ALL CONDITIONS LISTED BELOW: <br /> hKw'7DPJor <br /> ] c l� �!l a3 <br /> + q ✓t t5 . a) 5 <br /> yY1eG�- a N �,'I'bt G x Fee Rec: /51 <br /> d Check#: /47-, <br /> CD <br /> a <br /> 7 <br /> c <br /> 3Hk J <br /> Date of staff site visit: 13!/ Initi: s of site vi 't staff. r < <br /> APPROVED BY LAND SERVICES OFFICIAL: �,r,1/, - DATE:2./3 433 m co <br /> D <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C g a w rifd <br /> r C7 o 0 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 w <br /> Pagelof5 El <br /> Burnett County,WI Land Use Application—Rev 12/2022 c 2. <br /> 4 <br /> L J <br />