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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> • b <br /> Applicant Complete All Sections Below This Line 0 • w <br /> CI. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 • rt <br /> N p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 'r. g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 z <br /> Bunkhouse $250 0 <br /> �,/ Deck/Stairs/Patio/Retaining Wall/Sidewalk � ,� N (v <br /> �\ Driveways/&Campground Structures , 1 5 WI State Statute 59.692(1v)Structures $350 o i3O A <br /> Filling/Grading $150 Boathouse $500 ,,, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 m. <br /> "NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. (� „ <br /> *Communication Towers,Camping Permits&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. 1 <br /> 11 <br /> o , <br /> Property Owner's Name: , t C. CJ CAC' o <br /> Property Owner's Mailing Address: �. �j L1��'��j '`e--�- '- �l I.OW11'+Lri i/E; 1' <br /> _ City State Zip E <br /> Property Site Addressr��1 Le.4� (\' ..r i n (--A., _\t tc; mac' 1'L'1- �- `ie: o N <br /> Contact's Telephone Number: (LD� l.. `"�D�U� CD <br /> v <br /> Contact's Email: CY X-�r /0diii CU CA:it CA `... C C:) <br /> **If staff has a question abouis application,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 R. (IQ <br /> c'1 iC @BurnettCountyWLgov 01'�-� I � � �-' � � I � <br /> Legal Description of Property:A % 0j7_C�` --a ti 1" art a6-.11,cA Co -Oil`CO 6. d <br /> o <br /> Section#: '-(.1) Town#: LI I N Range#: 1 eD W Town of: ``'mLiJ 3 v, <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): ' 3 3 CD ( <br /> Proposed Use of Structure/Addition: liver^' fb*` <br /> Anticipated Start Date: ;,,LX• '2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,.,C . 6'� <br /> ., , y <br /> Building Contractor: A]Gt/4 C I AC - Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ) iO1t.ts+ Mee-- all se+ba.cs r <br /> a Tr' ( ?c ) rviw5-1- be ic,rto 80/2 3 <br /> z Fee Rec:_b_ "" <br /> o Check#: �/! <br /> m <br /> z <br /> �f tie v <br /> Date of staff site visit: 1/ I�� Initia of site isit staff: t7 li < (� <br /> m a D LI �1 LI <br /> APPROVED BY LAND SERVICES OFFICIAL: cn pp Ea <br /> , DATE: q4 wa30. <br /> 5 CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z o g wffil <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2022 v (..L J <br /> a <br /> i <br />