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LAND USE PERMIT APPLICATION - Burnett County, WI g <br /> Applicant Complete All Sections Below This Line �' c w <br /> Pp p a 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 �1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 vl 1 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 f <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `D z <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c ' <br /> V <br /> Property Owner's Name: t (X' (' t V\d 1I o Pill, <br /> o. <br /> Property Owner's Mailing Address: 9 'I 6,0 ,16 k,„iLV02.-6 S f . Cb <br /> i 17 ,-) <br /> City State ..Zip E <br /> Property Site Address: J' Ce\ o Eg <br /> Contact's Telephone Number: [5— ^(� "' i,) 11 i f' 1"-)l5 LI ci 'Q tH ' g <br /> .. <br /> o <br /> Contact's Email: d 14 ma I,rc&1t.Q. 4'tit . 'con <br /> **If staff has a question abous application,yewill be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and tr0 <br /> @BurnettCountyWl.gov crq <br /> �- �(� -7 '/�,/ <br /> Legal Description of Property: 5 1' 1i^ 4 QL- 5G -2 D'.� 3 Q'I I 137 . <br /> P PrtY < � _ i / .3n <br /> Section#: p� Town#: 3$ N Range#: VI W Town of: �kA tel`. cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> 00 i <br /> Tax ID#(1-5 digit number; found on tax statement): a et, (� v <br /> Proposed Use of Structure/ d tion: -S-ks!//Lt 6- <br /> Anticipated Start Date: ( / ( 3 • (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W ^ I O <br /> Building Contractor: P Sewer Installer: / <br /> �1g <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 /> J rv2ee-I- 41/ 5e4- e <br /> ki/ ,4/t It fA+;c01) <br /> z Fee Rec: /56: 0 <br /> d Check#:,0(�'O3 <br /> tri <br /> a <br /> z <br /> cA <br /> Date of staff site visit: 6 (a)-1d-3 Initials f site v': t staff:• <br /> ii1,1 <br /> � < ` <br /> 61?3//-3 APPROVED BY LAND SERVICES OFFICIAL: ' DATE: N a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z <= Z 0 <br /> rm .: i ilU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . o <br /> 0 <br /> Page 1 of 5 < - v.%) �` <br /> Burnett County, WI Land Use Application—Rev 5/2023 uDTI <br /> a <br /> s �C�J, <br /> 'e <br />