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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> < <br /> Applicant Complete All Sections Below This Line 0' w <br /> Permit Types and Fees(Please,check appropriate boxes) R.) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 P. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V� Ox". <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> I Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° IV <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' % <br /> Filling/Grading $150 Boathouse $500 <br /> c <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 /> 110 <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' "• <br /> z N <br /> Property Owner's Name: CI&.rID Pc -(C Iw.s 'r , <br /> °o <br /> Property Owner's Mailing Address: &t3can. UkK, -(t 41, d A,,b u ref ea i C'ti8 3 C� 2 n <br /> �D0 n (� S� City J State Zip <br /> Property Site Address: S' 4 i� N <br /> Contact's Telephone Number: 71'--3 44- 3 0,,,,/ a a <br /> N d <br /> d <br /> Contact's Email: 1144-1.-'k,l T.-s 14'it, Q g,r,,., , ce-...-, t" <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °Q <br /> @BurnettCountyWl.gov 00ul <br /> lt- V.26 P3/ ) <br /> Legal DescriptionC of Property: [LL�I .. ~ <br /> Section#: (- ` Town#: ''r I N Range#: Ile W Town of: 6--1k44- Lq,)�c 4 N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 5 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 ��7 a t7 <br /> Proposed Use of Structure/Addsyion: /) �,-el v <br /> -->~ <br /> Anticipated Start Date: G// i¢ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,ic -..G. <br /> Building Contractor: )'"(Or I 0.--grrucfvg,,,) 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 /> J ✓2iee-- cd( 5eti-W <br /> x Fee Rec:/ cx") <br /> v Check#: 13 3 <br /> m <br /> Z <br /> v <br /> 61 <br /> r ' ,� H-C—.• <br /> LT/ <br /> ' LJ <br /> Date of staff site visit: C/1 ' Initials of site visit staff: < r <br /> APPROVED BY LAND SERVICES OFFICIAL: (14-kle. 5F DATE: f 8,1,'j y Q.CD 3 U t <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> { v0 ca <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , w = o <br /> Page l of 5 < g `"' V� <br /> Burnett County, WI Land Use Application—Rev 3/2023 v (' ))I <br />