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LAND USE PERMIT APPLICATION - Burnett County, WI 1;'i c in: W Applicant Complete All Sections Below This Line <br /> Permit Types and Fees(Please,check appropriate boxes) v I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200W o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C-• ��. +� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o 1 kl <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 I o I <br /> Filling/Grading $150 Boathouse $500 <br /> IW <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ff I`-" <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. I `2 _ <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. g i <br /> Property „Owner's Name:_ �— d—G Y_ rai1,1_ <br /> qp IProperty Owner's Mailing Addr :5to5bGc Vi.feDeX i 5oL,7 , <br /> City State Zip I <br /> Property Site Address:_i5 Q "5...CSf g �_ l� o �— <br /> Contact's Telephone Number:_Thy,- 114:-__ ;Ridx) 1 N. <br /> Contact's Emai I:1._W_itl 15 G L`t C •a6W,. `� I <br /> "If staff has aquestion about this application,you will be contacted via email. Make sureyour email address is <br /> aPP N b , r--- <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and g. °° I <br /> @BumettCountyWl.gov . <br /> \ <br /> Legal Description of Property:Itr 1,OY\ LO?. VI - _ <br /> Section#: _Town#. li N Range#:__I.- _W Town of:__,.!-.t,C. __________ �� cn , <br /> *Attach additional page if needed for I- • y description OR attach a copy of the deed OR attach tax system property page.* I <br /> Tax ID#(1-5 digit number;found on tax statement): ip i (&ct, I <br /> H <br /> Proposed Use of Structure/ iti :_ @ air_ <br /> Anticipated Start Date:_ 3D' ._ Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' r-(. r-. -- Ci) <br /> Building Contractor:__ ______ Sewer Installer. L <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z ' <br /> THIS PERMIT IS SUBJECT T ALL CONDITIONS LISTED BELOW: <br /> �tks - /hee� 4,11 5e G�S '� <br /> i I VO-1- )( hvt� A 4 ,+ d� �* <br /> = Fee Rec:_/,') <br /> 422 <br /> a Check#._�77 3 <br /> m <br /> r <br /> n <br /> z <br /> o <br /> 51/aa3cn <br /> � <br /> m <br /> Date of staff site visit: _____r, it'- si v' 't staff:_ ____�__��_�__ <0f7r1 <br /> 3 cn m n ill <br /> APPROVED BY LAND SERVICES OFFICIAL: ,.,. ' • __��_ � <br /> _DATE: 1 ---- 4 m co n <br /> n n <br /> Pagel of 7 2 . -- [F <br /> Burnett County, WI Land Use Application- Rev 5/2023 2 0 Currl `C N <br /> m - W <br /> co <br /> I u J <br /> m <br /> 0 <br /> L )J <br />