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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> d ..I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '*. O <br /> Accessory Structure(Garage,Shed,etc.)0 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° A , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' rW`� <br /> Filling/Grading $150 Boathouse $500 C�. rn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. \ .t <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. cp i. ^ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. F, <br /> z <br /> n� o <br /> Property Owner's Name: 1 1(,.-S" 1 S <br /> J <br /> Property Owner's Mailing Address:(., 7 S . 06-?/ k..e:AL, b/ ,LR 5 In <br /> City State Zip E <br /> Property Site Address:Q—/73 5 (J&1T 1Zcb) b io7O'( titTr 5a o F <br /> Contact's Telephone Number: n. <br /> d <br /> Contact's Email:-7>f C.C._.b (L.S 17fn C. &L. 41 <br /> **If staff has a question about this application,y u will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °C <br /> @BumettCountyWI.gov o <br /> 0 <br /> Legal Description of Property:! T (7 C3 to 11? /g'(IJL) C �,1 L. 7 5 ) 6. <br /> Section#: // Town#: j./ N Range#: /4 W Town of:0A1C=L-4414 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f <br /> Tax ID#(1-5 digit number;found on tax statement): /3?CrL <br /> � �Proposed Use of Structure/Addition: 1%)( C- <br /> Anticipated Start Date: 3/t'5 ZC) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> Building Contractor: ! Sewer Installer: "7: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� <br /> N*9c- 6( h'c‘u leab.- 4 <br /> Otus}-- jrittk c,li 5 <br /> !1_'' f5;de- off- 3� i MeeiNk auA.S 514( P 4r>�. Ez oo <br /> ,�j )n�5 � ^�- � 'S x Fee Rec: <br /> o Check#: /6(0/0 <br /> m <br /> z <br /> z <br /> / u, t J <br /> A` rn <br /> Date of staff site visit: 23 Initia of site 'sit staff: C1 < a) <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:y gI2-3 y W a <br /> a -4 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF zoo �, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .. N Ind <br /> Page l of 5 < s w <br /> Burnett County, WI Land Use Application—Rev 12/2022 v L< JJ <br /> a <br /> i <br />