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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> - b <br /> Applicant Complete All Sections Below This Line o c w <br /> N t <br /> Permit Types and Fees'Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 VI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150. Addition/Alteration to Accessory Structure $150 '�] i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 N K <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 .» En V...., <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 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. F. `' ( , <br /> o v <br /> Property Owner's Name: r t e_.)rN ` �l <br /> o. <br /> Property Owner's Mailing Address: 33 (TaCe ITCL.Q.-Q_ MAYM I --.. "0 . <br /> City State �Zi ° `) ' <br /> Property Site Address: O / 11l! .< II <br /> o c <br /> Contact's Telephone Number: 715 7 l.' - oq LI 7 5 V 1O Cl. <br /> W v <br /> Contact's Email: 0 E <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and oo °O <br /> @BurnettCountyWl.gov on <br /> / - � � b O <br /> Legal Description of Property: C�74 Z CSG't U / 'C L41/4, /D . <br /> Section#: I ) Town#: 1149 N Range#: /5- W Town of: �G U'�- 1, V� <br /> cn <br /> *Attach additional page if needed for lengthy description OR attach a copy -- o e <br /> of the deed OR attach tax system property page.* —� .-3 <br /> H <br /> s <br /> Tax ID#(1-5 digit number; found on tax statement): 3(� <br /> /T V/ <br /> v -i <br /> Proposed Use of Structure/Addition: 11, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -.0 <br /> C) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m O <br /> MMTHIS PERMIT// IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ S <br /> cV/Ve /dc 4 00c/c- ca, opt S L T L; on/ h $7/z a 3, <br /> oe <br /> 1,0 A,keA q V.. / '4 (, a. i sOL�& c,74 al <br /> ! e CL/(,e !l it* 7, Fee Rec:0 -1/4 IS tedicYA-OL i' 14.v% tAt cie_c/c_ exidcinsici ,t aktd A4'.4/ <br /> �O �-- <br /> . <br /> . 1 o Check#: Z�7 <br /> m <br /> / � o <br /> Date of staff site visit: f//�P/70 Z3 Initials of 'te visit staff: r/► M <br /> / 00.9 CO n 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z. .v.„.ir)= o f1� <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF5. o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> • Pagelof5 tn� �` JJ <br /> Burnett County,WI Land Use Application-Rev 3/2023 v <br /> a <br />