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LAND USE PERMIT APPLICATION —Burnett County, WI A a <br /> Applicant Complete All Sections Below This Line 0' . w <br /> a i <br /> Permit Types and Fees(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $20006 O <br /> 2( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- '9 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 'o, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o V' '� <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0*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. g z <br /> 5, l5-** <br /> Property Owner's Name: A--& \ [(v' 1-/ <br /> ° le <br /> (�{. ( t?I) + <br /> o <br /> Property Owner's Mailing Address: 1 4 D I Pale ( o W t ' i � �l 5 & 3 I ,-, <br /> City State Zip <br /> Property Site Address: S k wl e /,, -7 C <br /> Contact's Telephone Number: ? ( S`" S�Cp- .1-7 15 �-- o a <br /> y d <br /> Contact's Email: Iikl'14l'l l a�' : Q,bel <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is b <br /> legible and your email provider will accept emails from the following addresses: @BuettCounty.org and tl0 rn <br /> @BurnettCountyWl.gov I <br /> / d <br /> (j <br /> Legal Description of Property: o g g. <br /> Section#: 0 LI Town#: 3 N Range#: / S W Town of: (k�d'1P fir �' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> )Tax ID#(1-5 digit number;found on to t I atement): 5 d <br /> Proposed Use of Structure/Addition: ° W <br /> Anticipated Start Date: 1 U- �- d9A I J�3 (Home/C(2b' ,,Commercial Business;Bedroom;Deck;etc.) * V r <br /> 1 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> eIr)e�- a,dl Se�bc,ctt5, �\ f <br /> IDT h4.4.40 haI)IT0,'tl.c>4 <br /> 3 �-or re s,' �hc�,I 0o� Vth:�kS z Fee ReccJSO <br /> c (' kf ok - W needs }v .f cle,. 7, <br /> o Check#: S <br /> m <br /> z <br /> v <br /> Date of staff site visit: (23 itial of situ vi ' staff: )-I < j <br /> APPROVED BY LAND SERVICES OFFICIAL:L� � ({ DATE:el /2-3 y co C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z NA <br /> vo r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - - w <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 u J <br /> CA <br /> -3 <br /> a <br /> 3 <br />