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LAND USE PERMIT APPLICATION — Burnett County, WI cr <br /> y. <br /> cn Applicant Complete All Sections Below This Line a w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) d k <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> "� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 � �`\ mb <br /> a......Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° l)' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 N <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ` <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. `D - <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 2. co <br /> o -- <br /> Property Owner's Name: /k 1^ < �6' /I� . !` o <br /> Property Owner's Mailing Address: 6 i H 7 O c t 4-C/1 M u/etg f e/ 1„lj i 5 Li g� I <br /> n <br /> ✓Q 2 Ft kc&S� ed-, I f.)0S , Li l 54Sa 3 StateCit Zip o <br /> Property Site Address: C / <br /> Contact's Telephone Number: ?f 5'2- -}2l <br /> 2'2 —7, J 1 t N i <br /> 11'' _ <br /> Contact's Email: Ili a C N►a r I a l j �;/0 4 u ' I t L `' <br /> **If staff has a question out this application,you will be contacted Via email. Make sure your email address is N b -C <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °O <br /> @BurnettCountyWl.gov ot, N <br /> Legal Description of Property: NE NE EX V22$ 10214 4, v42y PUS q{78 +1e0 3 - W <br /> Section#: 24, Town#: ,7 / N Range#: I ID W Town of: KI)Lri t1 v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0 <br /> ,' <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> -I !' ---- <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> V` <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • i,litri, 01- -10 -ex reed 3 b,j,roan s P.eI SIN-23- �-3 <br /> (r� II,^�n 11_�, ,�(r Fee Rec• 00 <br /> -LEI arlJl�� I(1��- �TU I @�. ma U�" frw v Check#: Ca5 <br /> m <br /> z <br /> v <br /> 1� <br /> Date of staff site visit: 5 j22./1D2 3 Initials of site visit staff:G(� <br /> n r'2 m p <br /> APPROVED BY LAND SERVICES OFFICI Q > DATE: �Q S ZDe7 Jvi <br /> n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' CDv N <br /> • Page lof5 < c <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 JJ <br />