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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> iAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <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 <br /> ili <br /> Filling/Grading $150 Boathouse $500 r <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z r <br /> d• <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. ,, 1 <br /> z <br /> Property Owner's Name:t2r.�`i .D -15 r e.n n e_�` o o <br /> . r, O lb <br /> Property Owner's Mailing Address: 1 I 1`3 L U 1c z 1-1"'e-'�1�, c LO i J`f E53 7 ?. n 1 t <br /> City State Zip <br /> Property Site Address: % k a i 3 C„,,, P.- rL. L I rt-cd 4-.r {:. U- 5'Lf 5a?7 o N • <br /> F <br /> Contact's Telephone Number: 1 j-- S (✓e L, — 2. 1 ) I a <br /> Contact's Email: I.. L.0 ‘.( rAt c'a.) C€r i u r Te 'I 0421 '' <br /> **If staff has a question about this application,you will be ctacted via email. Make sure your email address is N ro <br /> o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0. <br /> B <br /> @BurnettCountyWl.gov °Q <br /> u. <br /> Legal Description of Property: PP It if ( W ice'4 C501 V05j- -Q. J`'f <br /> Section#: oC d Town#: 1,7 N Range#: l t W Town of:1-1-Ac )2 L A-i.e: �, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number;found on tax statement): ?37 °4 �` W <br /> Proposed Use of Structure/A dition:'ep/aCj e 3 2` 32 <br /> Anticipated Start Date: -7//7 < (Hom Cabin;Commercial Business;Bedroom;Deck;etc.) ,v R `W, <br /> Building Contractor: Sewer Installer: v <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT I SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 11/,A uMAb1 k jb, " u1 <br /> Fee Rec: /S <br /> c7 <br /> o• Check#: 6,-5l� <br /> m <br /> r. <br /> Date of staff site visit: &15h.3 Initia of site it staff: )1l < 6 <br /> // P n <br /> 3 (I U tl <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: (p/7/42-3 v m C -n3" 0 <br /> <.3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o c- <br /> W C 1 V <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w N <br /> Pagelof5 n `° w <br /> Burnett County, WI Land Use Application—Rev 3/2023 c -�J <br /> i <br /> b <br />