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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a §. <br /> N <br /> Applicant Complete All Sections Below This Line a CD i <br /> w <br /> a. <br /> Permit Types and Fees:(P/ease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 . \ 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i()\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °r» V)'` <br /> '' <br /> • <br /> Filling/Grading $150 Boathouse $500 v, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 cg 0 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> Ir <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees.*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I. k <br /> R <br /> L <br /> Property Owner's Name: S/ ie fl A /"l^�C/1/lA/'� o o ` <br /> Property Owner's Mailing Address: T 20 /‘24 U lit 1 3 Mt` o 5 0 °. n <br /> ����pp City State Zip k' <br /> Property Site Address: fit/t / c y <br /> Contact's Telephone Number: ° <br /> Contact'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 b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° <br /> ga' <br /> @BurnettCountyWI.gov "0 <br /> G.m,' / c5wM !>, Z3 /f1 Z <br /> Legal Description of Property: a <br /> Section#: /f Town#: 3/q 51 N Range#: / W Town of: A U,S <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): Sg 3Z f .DO ---. 5 <br /> 1 -i <br /> Proposed Use of Structure/Addition: '� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> °Q <br /> Building Contractor: Sewer Installer: W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 6NOf' 7 6e (AM/ ice, Aut....gt. A0is/ 4ni. <br /> © Tfil'S /s Qh q G' p7 <br /> ,Fee Rec: 2 z, .® OtA7PeAr cliC/ NOTG .6+ / D a 71—qD c v.....it Lai- Sev / pc; tii ev14' y <br /> Check#: q f 5-0 y� <br /> 011 /Z/20/Z0Z2,- 4m <br /> z <br /> z <br /> 0 <br /> Date of staff site visit: ✓/ 9Z3 Initi of site visit staff: i, < <br /> n <br /> tri <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /049 Z' <br /> a <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF z <br /> r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 rn <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> a <br /> F <br />