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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> cn N <br /> Applicant Complete All Sections Below This Line 0 (14 <br /> II I <br /> Permit Types and Fees(Please,check appropriate boxes) Ca K) <br /> Dwelling/Principal Structure $300 K Addition/Alteration to Dwelling/Principal Structure $200 ' <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 0 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> X 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 /> v) • <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 C. <br /> b <br /> "NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <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 IP <br /> Property Owner's Name: r(///Jrt it n J c/I.;S G 1 '1.1 — J b <br /> Property Owner's Mailing Address: 2 6. / U C c/1 A,r f /-?t • t 1Q<L Gt/ 4'"c r CV 93 n <br /> _ City State Zip ') <br /> Property Site Address: -) ' " 5 #1\". H 2. — <br /> o g <br /> Contact's Telephone Number: 76 3" ''7" 1 ZiS co <br /> d <br /> Contact's Email: al y>n/le JG A,h/Se* C �j Mn/L : C-(n <br /> k) F'''...L <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: @BumettCounty.org and I. <br /> @BumettCountyWl.gov <br /> Legal Description of Property: L.f G4 / C cm V I !q ,222 d5. <br /> Section#: G ,/, Town#: 3 9 N Range#: /6 W Town of: - -e-e, d r, (,, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> � C7 <br /> Tax ID#(1-5 digit number;found on tax statement): J/D(, 7 <br /> Proposed Use of Structure/Addition: n /,t-rq, PiI th„ .� ,^,A p a,-sn Pail,6 e PQ.14 Cb Q <br /> Anticipated Start Date: /7 22, ,t1,',2 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M (5- 1 <br /> Building Contractor: 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 /> ieC-- all 5 6S r- <br /> ,,pell, og- + e'€d ) b{ ce i-tv. 54I;' 6775 <br /> x Fee Rec:3. — <br /> v17 <br /> Check#: 'jam %/ <br /> m <br /> 5 <br /> 2 v LJ <br /> Date of staff site visit:)/ Iq/? 3 Initia -of site visit staff: HE <br /> / <br /> APPROVED BY LAND SERVICES OFFICIAL: ,e,e,a DATE: 5/it /? 3 t E m n. 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a w <br /> lc N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �'` w <br /> TH <br /> Page l of 5 I <br /> Burnett County,WI Land Use Application—Rev 3/2023 0 `` JJ <br /> En <br /> a <br /> i <br />