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LAND USE PERMIT APPLICATION — Burnett County• <br /> , WI a <br /> N <br /> Applicant Complete All Sections Below This Line °" CD w <br /> Permit Types and Fees;(Please,check appropriate boxes) a <br /> G fo% <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 /> v <br /> 1 Accessory 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 ' L ' " <br /> Filling/Grading $150 Boathouse $500 - <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 /> ro <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. a "' <br /> z <br /> pp o <br /> Property Owner's Name: W. II co r. 1'�of 7 c <br /> Property Owner's Mailing Address: 13)3 Co �°)L,✓-cki 1)'- ,.(xc rA/S(l,l L P'r✓ 5-L z� 7 1 n <br /> �^ City State Zip ° 4 <br /> Property Site Address: ��c)5 7 -V'T lee web S (,t)E o y <br /> Contact's Telephone Number: (a P -7 Y) - 0 ° a <br /> I d <br /> Contact's Email: tdF U 9 /(-)A- (10,1.e' G 04i1 :o <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 a °Q <br /> @BumettCountyWI.gov ag <br /> Legal Description of Property: 6 L i 5'• <br /> Section#: /9 Town#: 0 N Range#: /S W Town of: Sv,--lc-.1©-/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F <br /> C7 <br /> Tax ID#(1-5 digit number; found on tax statement): 5 ya <br /> �Proposed Use of Structure/Addition: Po le-- S4 oci /�2�K co <br /> Anticipated Start Date: Olike, i' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) iN.- <br /> A <br /> Building Contractor: Sewer Installer: 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (\iZ a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> cV �/�©T 4 . GfS . /i' 4/44a n AePii .‘7Ce1/• `m <br /> D2 /l)of ex a A>,0`ff of 9 f <br /> Fee Rec:ii-5D' <br /> c Check#: Q2�Sff <br /> m <br /> z <br /> �J <br /> Date of staff site visit: /2��z3 Initi of s' e visi f: / :•. <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 00O Z3 f c___ <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF : 3 Z <br /> O IV <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Lai _ `cC <br /> � <br /> Pagelof5 c.'' <br /> DTI <br /> Burnett County,WI Land Use Application—Rev 3/2023 <br /> En <br /> L--=::3 <br /> b <br />