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LAND USE PERMIT APPLICATION — Burnett County, WIcy- <br /> Applicant Complete All Sections Below This Line g v w <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 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 `4 R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ O ,,; <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N� <br /> Filling/Grading $150 Boathouse $500 <br /> w <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. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,/tr such as:pergolas,landscaping,etc. R. z • <br /> Property Owner's Name: i VJ /" ��> ) o 0 <br /> o <br /> Property Owner's Mailing Address: id (4 �,P Q Sr sr 6��'�!/t/CIIN f0-c S`itY- , <br /> City State Zip c) II(�c�Property Site Address: J t.4- 5 ef: < E, <br /> co <br /> Contact's Telephone Number: &Si. 0 (D ^!l /�•f a <br /> Contact's Email: "-=�: 2A Tilek° @--- 4nAlt ii44L, Co , ro <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and `� °0 <br /> @BurnettCountyWl.gov cro <br /> ® j)O <br /> 5 NO v f / R. <br /> Legal Description of Property: �(!�l ��0� �� ( i/�Ui 1,�.� i w( I R. <br /> Section#: 7 6- Town#: [ 4 0N Range#: 12.i S W Town of: : 6C/ SQ/ —� c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> ' 5 <br /> Tax ID#(1-5 digit number; found on tax statement): 7 <br /> -s � O© <br /> Proposed Use of Structure',` d' (/9 <br /> ion: e( 1/A44 6412 'e <br /> Anticipated Start Date: 6> /(202?� (Home/Cabin;Commercial Business;Bedr om;Deck;etc.) <br /> Building Contractor: tiCr k is SAW 1 G� Sewer Installer: 14- <br /> @ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> p i4iee a It Sc 5 Q"\ <br /> e VA' '( fug 4,0i6v1-"u <br /> ,.),4'a t- ‘,)i7l 1 lel IP LI) <br /> 4cIdn55 iS neetteg 1 XfAilt. <br /> z Fee Rec: f 0 eV- <br /> Date of staff site visit: 5/167)3 Initials f site vi 't staff: 0-- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 5//b/?3 "a a ^' �. <br /> m 0 o <br /> N <br /> Page 1of7 ' N f...) <br /> Burnett County, WI Land Use Application -Rev 5/2023 • a <br />