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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 lb, N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure ,$150 Ci `2 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> o W <br /> Filling/Grading $150 Boathouse $500 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. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o' IP <br /> Property Owner's Name:_,c fe el k Lo r' G P v tin dale -, \N <br /> I `� b <br /> Property Owner's Mailing Address: 1 7(Q�S G l>e.n CIn I. n9 Rd, '6(3,t1�1X`y YV i S'{i3o . r, , <br /> �1(pS G lende h in5 City State Zip <br /> Property Site Address: ' aU(h►1bt�r y V�( 5 L( o y <br /> Contact's Telephone Number: at -150" -7 5 4 O "• <br /> Contact's Email: l D r 1 1 yr.r• tl e, r- s r . Cor(1 E °,1 <br /> o <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,,y <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org ando 00 <br /> @BurnettCountyWl.gov cm <br /> d <br /> �y <br /> Legal Description of Property: �Ok 4 CSn\ aa3 I VOL (3 P &a <br /> Section#: 3 3 Town#: ti ! N Range#: '(_p W Town of: 5 Lu I,S U, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r 11 <br /> Tax ID#(1-5 digit number;found on tax statement): aac�l7 WV("1) c� <br /> Proposed Use of Structure/Addition: "�f;`�(]� <br /> Anticipated Start Date: Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: 30,'0 j S e- S L-L L Sewer Installer: `) <br /> cp <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUB ECT TO ALL CONDITIONS LISTED BELOW: ._ <br /> e,e-i- J Se <br /> b4U IV's IS- <br /> i Ne4 -2,17 k.,,i'vL. n ilci))i 1 c"---k 64 <br /> = Fee Rec: 9'i <br /> 7, <br /> 64 Check#: � � <br /> r <br /> Date of staff site visit:L5/I61 a-3 Initia of site isit staff: v1L < i �� <br /> a 1 <br /> APPROVED BY LAND SERVICES OFFICIAL: �(� DATE:S//9`a-3 g <br /> -I) co <br /> Page 1 of 7 , o <br /> Burnett County,WI Land Use Application—Rev 5/2023 ` c <br /> `c Na <br /> U <br /> J J <br />