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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> N, m N <br /> Applicant Complete All Sections Below This Line = e w <br /> Permit Types and Fees:(Please,check appropriate boxes) V.l <br /> C7 <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Z <br /> XAccessory 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 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 P <br /> AD <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 C� <br /> *NOTE: After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ' 4 <br /> v <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 <br /> Property Owner's Name: ' �t, AA- S e`�3 i"r` � o o ` <br /> pMailing ei 7©to C&t�vie?es $6'1--.d f, - `' f <br /> Pro e Owner's Address: f 11 <br /> 5 � Inv <br /> /, G City, State Zip k <br /> y Property Site Address: 7e! o L' d`2C�C ' S 4 1,----1,---- f e ' i <br /> e6G" --VC-, 17/_L 5 t` tg 0 - �g <br /> Contact's Telephone Number: 1/ tJ — 7 97 �6t3 0 a <br /> r° <br /> Contact's Email: U"�A Glf ..`. y !G c,'c.- C C" , <br /> **If staff has a question about this application,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 z °0 <br /> @BurnettCountyWl.gov �} <br /> --3 o <br /> fJ 0A fe 0 <br /> Legal Description of Property: / 0. <br /> Section#: e2 Town#: _3l N Range#: l' W Town of: h,.r",i E-c.1 c, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N Crf <br /> Tax ID#(1-5 digit number; found on tax statement): 1/ tr <br /> ti ! --...._ <br /> Proposed Use of Structure/ ition: . ' r/� d <br /> Anticipated Start Date: C' // -3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <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 /> -1074- sk-FfoaLS s <br /> •N D4- Win Hab( '6') <br /> p Fee Rec:4 150 <br /> ��erm 11 oc Aires l�4 21 I2azy. f f rnt-1-' f yAtnst crt n e L.dLd c -Ee_c —}�.0 s m Check#: 2031-1 <br /> 0�a �-� - p r�je c.-� . S r�o+- Co npl.�-t-e. z <br /> Date of staff site visit: (1/5/2023 Initials of site vi 't staff: < <br /> nrr, w <br /> APPROVED BY LAND SERVICES OFFICI DATE: (i 2/ 20Z,3 '— f(^)) <br /> > tD W v (/ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o c, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT x, CI.. N <br /> Page 1 of 5 m `� <br /> Burnett County,WI Land Use Application—Rev 3/2023 v ' JJ <br /> H <br /> a <br /> 3 <br />