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i:eCO\ about:blank <br /> LAND USE PERMIT APPLICATION—Burnett County,WI i g b <br /> Applicant Complete All Sections Below This Line `_ 1 o w <br /> Permit Types and Feeselease,check appropriate boxes) <br /> mV <br /> kV <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `8 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I J 4 <br /> fff��_ <br /> Accessory Structure(Garage,Shed,etc.) 50 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 /> • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> 9. <br /> Filling/Grading $150 Boathouse $500 I 1 <br /> Solar Panels(Stand alone or roof mounted) r 4$150 Permit Extension(1 Year Extension-Allowed Once) $100 . <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 g• <br /> , <br /> Property Owner's Name: I ro y + A, sct Aete r‘reck-‘ [� "I <br /> (� r <br /> Property Owner's Mailing Address: 2C? Sanbctrn0I ales 5P4 eP2rL rhn SS1/3Z 1, + <br /> / City State Zip E' <br /> Property Site Address: 3 Ai 1 r9 it ` r mce L b+ 53 a .. °^ <br /> o 3 Contact's Telephone Number: (/2'2k6" 9c' 7 j I. ¢ <br /> d <br /> Contact's Email: '' `Q/jet$p r 672.? Q aitiAil . C.v'tn <br /> **If staff has a question about this application,you'%Gill be contacted via email. Make sure your email address is 'N ,.0 <br /> o <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and = to <br /> @BurnettCountyWLgov rA <br /> II__ �� � " ! <br /> Legal Descriiptionof Property:5_1'IiJk U q tU1n -To V egte Nttd5L to-1- 53 <br /> Section#: 22 Town#: qv N Range#: IS W Town of:C/ 7p,,t Sbr' . 'v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I 11 `4 <br /> .8. <br /> IN 1 o <br /> Tax ID#(1-5 digit number;found on tax state ent): O 3�9 a { <br /> -i CA ! <br /> Proposed Use of Structure/Addition: P <br /> Anticipated Start Date: J St (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> y7 O ci, <br /> Building Contractor: Sewer Installer: I, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1_ I <br /> - I y t - ,'t� ' S !V' j <br /> N04- -fir h - " hfkbA-0,4i(Y-A oz) <br /> g Fee Rec:*/�� <br /> o Check#: /O yi0 <br /> m <br /> r /202?> <br /> i <br /> Date of staff site visit:`1 16 Inn of site visi stag:T <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE:7 I D `1 U23 l, <br /> 1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF E. <br /> cocn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a = c <br /> r <br /> ffil <br /> Page 1 of 5 g y n w <br /> Burnett County,WI Land Use Application—Rev 5/2023 g E o <br /> ta•Z" w <br /> EN <br /> 1 of 5 6/10/2023,7:49 AM <br />