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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line 0 w <br /> 'ermit Types and Fees:(Please,check appropriate boxes) g ; <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 N• <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 (3) <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <- ^telq <br /> Deck/Stairs/Patio/Retaining Walt/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125_ WI State Statute 59.692(1v)Structures $350 o UJ <br /> Filling/Grading $150 Boathouse _$500 iiii: <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' isi‘" <br /> 'Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. S <br /> 'Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -' .--.,\ <br /> 9 <br /> ?roperty Owner's Name: t Yr—e +- .Tile- ) cc 13 i ec-?- ' }.) <br /> ?roperty Owner's Mailing Address: 6 4)-3 J`1./ Sf. Ai- Nv. () /kW 5j C. <br /> 1 ,) j�� ,t City State Zip. Cl) <br /> ?roperty Site Address: 4 O 7�u f S.1 (/� tK. ADC • Luo-`"/Y er --`.l 9 t?? ' ?, <br /> o_ V <br /> 2ontact's Telephone Number: 47 5 / ;�--7& y"3 ) c 5 <br /> zontact's Email: J{'PtPb1 ee..5 &ci (Mt/1 j C0• v ". <br /> e*If staff has a question about this application, ou will be contacted via email. Make sure your email address is <br /> egible and your email provider will accept emails from the following addresses: @BurnettCounty.org and c f0 <br /> &BurnettCountyWl.gov r <br /> -egal Description of Property: 5a� C)12. Tn r �:• O� r� .S c. S u. <br /> Section#: 01 Town#: 3 Y N Range#: /t W Town of: . ee 7O' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C> o iv <br /> fax ID#(1-5 digit number; found on tax statement): 1 I Q 3 3 <br /> ?roposed Use of Structure/Addition: 'A House_ --- <br /> Antici ated Start Date: etc.) ..it)) (� " <br /> p � ��� `��� (Home/Cabin;Commercial Business:Bedroom;Deck; O <br /> 3uilding Contractor: Sewer Installer: jO <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z CO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> giheeA- c�� se}-b.c,Q(;r (hus-, be f► ,6„n. serace Aftdose or se ' s s�}ef-r art <br /> :k be sled SIG t bNnGlbe,4se. Ne ;Ado•r- bonioe v41 S$ <br /> e44 4. Cly S;Zed Se h"c. z Fee Rec:(5° CV <br /> �� lz <br /> CV �' ilk/1Ji/tse Covf/t4 o Check#:ii,3J <br /> tr <br /> > r l� <br /> D i— G <br /> Date of staff site visit: 5 I AI I33 itials of sit vis. staff: WE < a W D U u d <br /> C n --, <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:5412 3 y ` ' Er,�i <br /> m CD � BUU <br /> m n (..rt <br /> vo 0 <br /> Pagelof7 ,z N. <br /> Burnett County, WI Land Use Application—Rev 5/2023 :` g CO` im <br /> CT <br /> SI l ) Ji <br />