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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 5 c w <br /> Permit Types and Fees:(Please,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 <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- J <br /> \� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk � Bunkhouse $250 ° � -� <br /> Driveways/&Campground Structures (T54 WI State Statute 59.692(1v)Structures $350 o S <br /> Filling/Grading $i� Boathouse $500 <br /> K <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 B. _ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. 1 <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. _. -. <br /> o c <br /> Property Owner's Name: V( b �} i S '� 2- <br /> w1 �y67a <br /> Property Owner's Mailing Address: q to 7 s "DAB 1 E.L.5 7 s, .. n <br /> City State Zip "' <br /> Property Site Address: 5e < N <br /> c�Oab1 /55ti5a ° <br /> Contact's Telephone Number: a <br /> Contact's Email: dc3U e-a_a_o\e 5 IRS e G IM l L-t co✓,N, <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 0 LI <br /> @BurnettCountyWl.gov <br /> 1 (5'i V 7 P1 �-k. � Des c L/S3/647 64 (-vv. /M.) <br /> ro <br /> 0. <br /> Legal Description of Property: 7 ✓ 5. <br /> Section#: P ' Town#: 36 N Range#: 1 7 W Town of: b(' f p(3_ v) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* '- <br /> Tax ID#(1-5 digit number;found on tax statement): °� � _ 6 <br /> Proposed Use of Structure/Addition: epS_C. ' <br /> Anticipated Start Date: -D — 2-4 2 3 CO/Cabin;Commercial Business;Bedroom;Deck;etc.) Ul / <br /> Building Contractor: 55e-C—I Sewer Installer: (�^ V` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> d✓►1-ecI- a1( Se7DaG S �1 <br /> x Fee Rec: l <br /> o Check#:�3 <br /> m <br /> z <br /> v <br /> m p� <br /> Date of staff site visit: t/ 3 /d-3 I 'ti is of sit visit staff: < n <br /> � � �7 n <br /> ilifil <br /> APPROVED BY LAND SERVICES OFFICIAL:// M DATE:el71 ?--3 . m m v v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 0 e- <br /> � � . N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g <br /> Iffil <br /> Page I of 5 tri <br /> '< <br /> Burnett County, WI Land Use Application-Rev 3/2023 a <br /> a <br /> M <br />