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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line a a w <br /> Permit Types and Fees:(Please,check appropriate boxes) >c Cl.CC <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure 5200 , <br /> Commercial/Industrial Structure $300 Additicw./;`,Iteration to Commercial/Industrial Structure $200 10 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> 8 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 I N <br /> (Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 21 <br /> 9_Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 W <br /> Filling/Grading $150 Boathouse $500 i o I tm <br /> Solar Panels(Stand alone or roof mounted) I$150` Permit Extension(1 Year Extension-Allowed Once) r$100 \l,\ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `< <br /> !'Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. I q , <br /> I*items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> z• <br /> t <br /> Property Owner's Name: t) G �- i. /c ie e rJ f / cc)S•� I 04 o <br /> Property Owner's Mailing Address: 3,'3 0 ,Z £/1 e t ,/Qr' to ,fi,r,b es w n �` <br /> City State Zip 1. 4 <br /> Property Site Address: $3 e R ,D f1 e r' n,, AC Y' r( %r I / + (1,, <br /> Contact's Telephone Number: ci -01- ') ) ..Z. b o2 / i•-• a <br /> C).1 <br /> d <br /> C',.,.,t, t , i n;iii A-/-0 r, <br /> **If staff has a question about this applic xi n, eti w�ll'be contacted via email. Make sure your email address is I Ac Ib <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° tl° <br /> @RurnettCountyWl.gov '° 4 r_ <br /> Legal Description of Property: q• <br /> Section#: / Town#: g N Range#: /,1'C.%'W Town of: rt <br /> 73 v <br /> ,ittach additional page if needed for lengthy description OR attach a copy of'the deed OR attach tax system property page.* E <br /> `..0 E <br /> Tax ID#(1-5 digit number; found on tax statement): /g 2 2 <br /> Proposed Use of Structure;'Addstion: Ke-rhUt icl -S`�/t/Gre., 46 <br /> A09.4)--7z <br /> Anticipated Start Date: 2— / A 3 (Aome'Cabin;Commercial Busin s;Bedroom;Deck;etc.) <br /> Building Contractor: Se_/C Sewer Installer: ..4}-4- _ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAY'CoMMr+NTctf'nt`TT.Tmt(W (WI v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 a!( 544)4-ct, .... . <br /> rr ^o /1j : ,✓t ,ine i°nf- elh5' Gq• 61(toil) <br /> $41UriaA,_ <br /> �e z Fee Rec:/52 <br /> o Check#:i�h� <br /> m <br /> r <br /> z <br /> Date of staff site visit:(! ?0 2-3 ;ials site vi ' staff: /IC C=1 MAPPROVED BY LAND SERVICES OFFICIAL: DATE:__OW 0- `'_ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF' o z s Z Inn' <br /> z y — lJ�+u <br /> �'� '1T'�''- �'rl'"``ar'' =_�'P��sCATION IN PLAIN SIGHT m = cm <br /> — _ Page l of 5 nil <br /> e) - w <br /> Burnett County, WI Land Use Application —Rev 5/2023 3 <br /> L� )J <br /> D <br /> 3 <br />