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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees(P/ease,check appropriate boxes) ° . <br /> d �o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n .4 <br /> Commercial/Industrial Structure ,$300 Addition/Alteration to Commercial/Industrial Structure $200 0 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ry CD <br /> g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� �` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o W <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 F_ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `� ft. <br /> ro <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. "' <br /> o n. <br /> Property Owner's Name: 2,ErL) eL , <br /> J/ if <br /> b <br /> Property Owner's Mailing Address: 7 .�'y k1 h. /j el S�o0/t tr �5 6 W/ w, n <br /> sty State Zip k) <br /> Property Site Address: NA . o y <br /> Contact's Telephone Number: IVA ° <br /> WIContact's Email: w <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °Q <br /> @BurnettCountyWI.gov ao <br /> 0. <br /> Legal Description of Property: GOV LOf 3 5'. <br /> Section#: 1 Town#: 3 g N Range#: 11/7 W Town of: 0 C,fit/9/ c, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0 <br /> Tax ID#(1-5 digit number;found on tax statement): c:: , 1g4, <br /> Proposed Use of Structure/Addition:Prod A- €ern p Pe- M <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor64 M &I fig.cr,c1A Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ptYiee+ aII 5ebg1 4- <br /> 0 <br /> x Fee Rec: 150 <br /> -:5 S'IL CIT^v-e ;5 am ex`. '1 9 1Q Q p(ogt..C4- be;/tt So l cf• o Check#:C�..5I1 <br /> cJ m <br /> o r-2 I <br /> rn <br /> Date of staff site visit: 1l It R /a3 Initial of site vi ' staff: Y m j� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: L`/ 3/20 y ci. fiD ll u 11 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Z inn' <br /> 1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g c4 <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2022 v LL- )) <br /> a <br />