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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a 'It <br /> Applicant Complete All Sections Below This Line w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 . <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v <br /> �( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> / Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G-" it <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 oV ' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 NI <br /> v <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> w <br /> 'NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `. <br /> -o <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. "- 4 <br /> o <br /> Property Owner's Name: >J;j i, l-..t t RpoU A J), /�q 2 y-G.4kv 4) =' <br /> 0 <br /> ` 0 <br /> Property Owner's Mailing Address: 021�63e9 EJ�6?-- 1 A) ,�Dc �� I,ui: y C'/ b - <br /> City State Zip 4 <br /> Property Site Address: /VO f e- < r\ <br /> p Ga�1 y4V ILL G�4 Sl o g `' <br /> Contact's Telephone Number: O/S ,3-j 9 CA-LL r.✓l3%U yc'i! G2A1 N a <br /> t7 <br /> Contact's Email: ,tj i‹,t y CAl2 P y 9 �/%'i,T L- , C cE`'� D <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 = °Q <br /> @BurnettCountyWl.gov n <br /> d <br /> V 5 zy 7,,Go f-0 cw1 <br /> Legal Description of Property: Z <br /> Section#: f Town#:.: 9 N Range#: JL/ W Town of: R v;i.' V <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o x <br /> Tax ID#(1-5 digit number;found on tax statement): �-,/ DO 3 C7 <br /> I "3 <br /> Proposed Use of Structure/Addition: i?ftil e 1% Al <br /> Anticipated Start Date: ,SI/, ," 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor��,�-lizoC1(,13.,trf.b�S Sewer Installer: /VA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �, P THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 6 No74 74, de usc-0/ -7CrAapvtopl Cleti./V-Stio^.., ..."k <br /> s Fee Rec: 60— <br /> o Check#: C jd- <br /> m <br /> r <br /> a <br /> z <br /> v <br /> Ln <br /> rrl <br /> Date of staff site visit: 5/V040 Zd3 Initials o ite visit aff: ;/ /' x v r <br /> n 111 <br /> D <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ....4.— /Z-ea3 rn 0co <br /> c -a <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 0 y 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> fl <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 LL <br /> a <br /> b <br />