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f LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> �' N N <br /> Applicant Complete All Sections Below This Line 0 <br /> 0 c 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 C.... 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 _\\cp <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> .J D• eck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a <br /> D• riveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ' <br /> Filling/Grading $150 Boathouse $500 S <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. C <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> *Items not listed above will be treated as accessory str ures„such as:pergolas,landscaping,etc. ' <br /> 0 111 <br /> Property Owner's Name: /Pa.n 61"-- o <br /> Property Owner's Mailing Address: ' 5 { 0.--zii-g,i/ , .. <br /> i,,f,e.&7 �/ ,:J ,�/ <br /> • <br /> �i9-E. n <br /> ._State Zip E <br /> Property Site Address: // •-.. it �� ;�'� d// l?/4', £ ,�'./; / <br /> �jJ// N <br /> Contact's Telephone Number: —_�� J 7 l ° <br /> ` L d <br /> Contact's Email: 7/i/o 47 yQ��G, 21CD <br /> **If staff has a question about this a lictltion,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: @BumettCounty.org and <br /> 5' <br /> @BumettCountyWI.gov ao <br /> Gs/ 1/ ,� d °� <br /> Legal Description of Property: ZS. / �+ /�� 3 <br /> Section#: 3Ce Town#: re N Range#: /y W Town of: Le,' r„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* V <br /> Tax ID#(1-5 digit number;found on tax statement): / 8' Sgy 6 <br /> t <br /> 1 H <br /> Proposed Use of Structure/Addition: Fytiv_ P►s7L/P4 f/G <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: Sewer Installer: ` s'‘) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> N. <br /> 0 7f l S Pea"van i'7' )5 —r re -''re, p'Y ci i^e ct a 5 M4 w►71-ro A e 0/ '`. <br /> IA 4,6P- zz - V 'O, <br /> • Fee Rec:t <br /> o▪ Check#: 6' 2- <br /> m <br /> ✓• 1 <br /> /um <br /> Date of staff site visit: S/ 7 ea Z3 Initials o ite vis' taff: AZ— Fso <br /> tt �,�,' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ..C. a2 Z-3 Ito >. E u u <br /> i 5 ;3 V V <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ^? <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> Page l of 5 5 iffl <br /> Burnett County, WI Land Use Application —Rev 3/2023 v �L JJ <br /> a <br /> a <br />