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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line vi <br /> ° c w <br /> PP P ° a , <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) K.,,,Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 9Q <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 �) <br /> Filling/Grading $150 Boathouse $500 �1 <br /> g <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 k <br /> a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Z c'S <br /> Property Owner's Name: iQ 41k;f3*`0 (r ' • <br /> o <br /> Property Owner's Mailing Address: (mot)i i grj 3 1(,j 4- ,4ti c / ,t�i,,cl-rQ CO: S u'zL . `, <br /> �J City State Zip 4 <br /> Property Site Address: 3(DC-57 LA..tILiiti LiI-Lt> K >. t .)B:� tU:' 5-Lf3 c: o , <br /> Contact's Telephone Number: 71$ 3 -/ �( / <br /> ,, <br /> C7 <br /> w <br /> Contact's Email: he•N et: L s) 4, (A!L.. 4,.,.i , `' <br /> **If staff has a question about tha applkation,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 ° °O <br /> @BurnettCountyWl.gov <br /> C7 <br /> Legal Description of Property: r C_L. .i A; ig /S\ ,j C^l E= 3: <br /> o <br /> Section#:>}q Town#: If( N Range#:(,iR,St,Jc W Town of: f SS _ c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): c9 15 3 <br /> Proposed Use of Structure/Addition: 6:23.4_66-,,; 5i-h_:.__5 9J E <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �, <br /> LA <br /> Building Contractor: AA Sewer Installer: /V 4- <br /> 13 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> la, heel- all Sep, r` <br /> a2 No f &'( ho snxt4 01`f koi <br /> x �Fee Rec: (� <br /> r <br /> v Check#: .j a <br /> m <br /> Z <br /> Date of staff site visit:51;11 ( ''3 Initia s of site isit staff' /4 cr <br /> r) fl <br /> 5 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7 JI 3 y �° n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z y � w t�ifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a N-) c4 <br /> Page 1 of 5 m �ll <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 <br /> a <br />