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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> cAPplicant Complete All Sections Below This Line w <br /> N , <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> b <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '� 2, <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 PD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C" , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 F. ( J <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> .o <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. c •-. <br /> o <br /> Property Owner's Name: } 6 d ��>�(5 C;, G X Lc C'i^., F <br /> L�. 8. <br /> Property Owner's Mailing Address: [I t d( cs 1 c,r 1.--0_ _, t 5-k-,ec c ' Fc, I/si Cv;l 54iO4 a. ri <br /> �� <br /> (� City State Zip ci <br /> Property Site Address: �L(5 `>.c Cs Vim.n Q.C104( 5couv\.91"1 Ci„1 t $ '-j ea I Q <br /> o n. <br /> Contact's Telephone Number:) ( 5 S -cf`f P 7 j 5 _S 53 .G L(� P <br /> b <br /> I/ <br /> Contact's Email: (' r C v,.4S i.,(-1 C O t U( K--- C-� �. `n <br /> **If staff has a queitabn 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 <br /> @BurnettCountyWl.gov aci <br /> t? <br /> 1 <br /> Legal Description of Property:C I-7 `C ,)(}p ' —L(Q -- '1t -1 ) —�1 Q 1 - 0 0 0 ` 0 ( ( ado— 3. <br /> Section#: \ Town#: 44 L N Range#: 1 L/ W Town of: 5 c_c"f u) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* — x <br /> Tax ID#(1-5 digit number;found on tax statement): ! // N d <br /> H <br /> Proposed Use of Structure/Addition: -c�he_. 1 Co,r�' r1C0 P O`,r i <br /> Anticipated Start Date: Al 7 ). (Home/Cabin; mmercial Business;Bedroom;Deck;etc.) Q �r <br /> Building Contractor: . i A Sewer Installer: / v A1 <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 /> — /I/tLQ + C U S,C-�S —c <br /> — NA4- AY KWAPILL4(1 i'l,")" l D/1 x Fee Rec: I Q= <br /> 61 <br /> Check#:,3L I3 <br /> ro <br /> c <br /> p <br /> Date of staff site visit: 6/1o12123 Initials of site visi staff. " = <br /> p./ r <br /> Q!APPROVED BY LAND SERVICES OFFICIAL: DATE: ei Z,J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '.3 0 <br /> Fa <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w. = r,v <br /> Page 1 of 5 CO <br /> Viril <br /> Burnett County, WI Land Use Application—Rev 5/2023 <br /> LJ <br />