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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Feeselease,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r O <br /> Accessory Structure(Garage,Shed,etc.) , $150 Addition/Alteration to Accessory Structure $150 = <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 4 lb <br /> X. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> LI <br /> Filling/Grading $150 Boathouse $500 '` <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. i % <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 'S <br /> z <br /> Property Owner's Name: `�/�• C O /y—(> P rt{ ' y (.-t-� o r <br /> ► . <br /> '� VP OP (2to (S-C: 9 ) (A.I . -- 7 <br /> Property Owner's Mailing Address: tl •® ,. Sv0. lip <br /> -... <br /> Sta <br /> Property Site Address: a 2-2- '3 c �2 p (� Cl�a�i l}w t Zip �,'� < <br /> (� J O y ik <br /> Contact's Telephone Number: 1 I ' + .,)_O q — L,D 4 3 5 c J,- '- .-3=' n A' <br /> d <br /> Contact's Email: V.e 11 e N o k 4-k court-`)r iiz_L,pie.k e S , C 0"1'1" 3 cr. <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @BurnettCountyWl.gov ao <br /> d <br /> Legal Description of Property: Let 1 t S re- 4 g L c V .77 f 3 O (p I'C�C,. 4(p I S S 8 <br /> Section#: Town#: 'b N Range#: l � W Town of: Octk< Le N u) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* H <br /> Tax ID#(1-5 digit number;found on tax statement): 3 S— Li 34 'u.3 6 <br /> a <br /> Proposed Use of Structure/Addition: tf L. '--rk...._ <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) t� <br /> 0 <br /> Building Contractor: Sewer Installer: `` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> yy1 ee4- a l I Se-I-b4, <br /> f <br /> Ada- -� 1IKln�,n ham. o' <br /> Fee Rec:l/ vfl <br /> 6 Check#: %?9(p <br /> m <br /> z <br /> v <br /> ,/,3 Date of staff site visit: Initial of s' a it staff: lib J J <br /> n g <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/ -.,/ -3' N n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <0 <br /> 0 <br /> z mITH <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o g f '—' <br /> a w �. <br /> Page 1 of 5 li w <br /> Burnett County, WI Land Use Application—Rev 3/2023 v = M' <br /> cn <br /> L� -J <br />