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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WIcrApplicant Complete All Sections Below This Line 0. w <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 U r <br /> 2c Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 • <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 w . <br /> IC <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. i <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. InE, <br /> z p <br /> o <br /> r---) <br /> Property Owner's Name: \n! 1\\ it0\iM ,Q.Ci'1. ,c,\C..1 .r <br /> CD. r <br /> Property Owner's Mailing Address: ��` (�vf-z 0 \)t4 `J \"r� 1 ;'-r <br /> City State Zip <br /> Property Site Address: I it 0 f7*c O e '��-VI\V. o c <br /> Contact's Telephone Number: 8 3 � `�1 S� 1-1 \ . . . :-9L Ia. <br /> d <br /> Contact's Email: t\1, 1 i 2 `�-A S g C 0.\1\ '' C VY\ CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5. <br /> @BumettCountyWI.gov o ► <br /> V d re.).1 <br /> Legal Description of Property: L Q ` 2 CS ,i <br /> Section#: 0Town#: LA,® i N Range#: i 6 W Town of: © k cx.h A v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* _ i <br /> Tax ID#(1-5 digit number; found on tax statement): "1 � 5 1 <br /> Proposed Use of Structure/Addition: S C 0) _� S 1 Occ\c'y 1R 41 t c&C.'E% v\9 t^�,` «IC) 0 1 n ,-3 <br /> H ,.. - <br /> — (Home/Cabin;Commercial Business;Bedroom;Deck; <br /> Anticipated Start Date: S ' �3 etc.) <br /> Q <br /> Building Contractor: 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 /> fil <br /> ® 1V0-1-- -{.a exceed re- /lo 64 t 12) <br /> Fee Rec:-�-c - <br /> FAA )la✓e ?ePelf51. 6 9 ►a M) c Check#: //!3 <br /> z <br /> z <br /> v <br /> Date of staff site visit:5//2-//d- 3 I .ti is of site"sit staff: ,16 < �C_ J <br /> APPROVED BY LAND SERVICES OFFICIAL: {pQ, DATE:. /3 /2-3 til OD <br /> a l <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o ?3 <br /> z m .. ns <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT { y "' <br /> w N <br /> Page l of 5 < 3`( N <br /> w <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> J <br />