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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees:(Please,check appropriate boxes) d N a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �' `,..)0 <br /> 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 " 1 O <br /> x Accessory Structure(Garage,Shed,etc.) ` ` <br /> $150 Addition/Alteration to Accessory Structure $150 li i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 << <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r • <br /> Filling/Grading $150 Boathouse $500 .» <br /> Solar Panels(Stand alone or roof mounted) $150_ Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `' <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. o z t <br /> Property Owner's Name: `BAN 1 )U LLI.(Ir —, o <br /> a. <br /> Property Owner's Mailing Address: y 4 51 Pio eiJ 1 N(, S TA/2 OR_ -DI}L)BLIVI w) 541r.1. n <br /> City State Zip E <br /> Property Site Address: M rG IPP-p. o N <br /> II <br /> co <br /> Contact's Telephone Number: 9 5 Z -4160' O)9 L a <br /> d <br /> Contact's Email: dgno c7c 1 MStJ, CO,v� ep <br /> **If staff has a question about ti is application,you will be contacted via email. Make sure your email address is N ,ci <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and cm <br /> @BumettCountyWl.gov I <br /> p <br /> Legal Description of Property: N10 N i u(, STA P ADD)7100 LOt 15 4- I in 5. <br /> o <br /> Section#: II rj Town#: 4.1-0 N Range#: I S W Town of: -,Prc opJ TOWI)SL1.,'P v) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C, p,) <br /> 7 <br /> Tax ID#(1-5 digit number;found on tax statement): 1 1 y 7 <br /> H <br /> Proposed Use of Structure/Addition: 6yp.Q.p,!�Q. V <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z., kO <br /> , ...,. <br /> Building Contractor: Sewer Installer: \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 6)✓1 eel- a i( se be U\ <br /> Fee Rec: j5VC <br /> o Check#: l/3 <br /> m <br /> z <br /> C ^�`� rn <br /> v <br /> Date of staff site visit:5� 0 Initia of site 'sit staff: <br /> ri &,— <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:,SP- ? 3 COCA CD <br /> a m C 3> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z GIN <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . (D= o `� <br /> Page l of 5 � 3 w <br /> Iffil <br /> Burnett County, WI Land Use Application-Rev 3/2023 v (.�____2. <br /> __ <br /> 3 <br />