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LAND USE PERMIT APPLICATION —Burnett County, WI a 2 b <br /> Applicant Complete All Sections Below This Line 0 0 c <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> cc? Vi <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure,i, 3Ce $300 Addition/Alteration to Commercial/Industrial Structure $200 � p <br /> Accessory Structure(Garage,Shed,etc.) X Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 (`J <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 .S <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S "' <br /> o <br /> Property Owner's Name: -1'41'g Q <br /> �l 0.0 t5i , <br /> °o aol <br /> a. <br /> Property Owner's Mailing Address: j I to`i O'Ci 6e.:4 raj Lel L;c�£,(�?TI`rL- Lt; i 5yf¢I 3 w <br /> City State Zip ° E <br /> Property Site Address: ;1 lei& L vN` i N L 1 13!4-0 -1 � A.;i °f `f 3 o N <br /> Contact's Telephone Number: I / C— ,-6 7/4 .5 H a <br /> W d <br /> Contact's Email: t a i.t c IlL.'t3 e".' L 1 £?. ' v/-f'l i4&_''`"yj <br /> **If staff has a question about this apication,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 °Q <br /> 5' <br /> @BurnettCountyWI.gov m <br /> t�1-O -- L — c)._ /L y-2ii— —0. ..,4%c�() 0 /Ze,:`e3 a -J <br /> Legal Description of Property: 0 �{ <br /> Section#: Town#: N Range#: W Town of: c9;4-t_L-tcliN 0 co <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> � 5Tax ID#(1-5 digit number;found on tax statement): �j ,_ <br /> -3 <br /> Proposed Use of Structure/Addition: TU'i``+ 4'6- ki <br /> Anticipated Start Date: 2 '1_.0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) . (/v <br /> Building Contractor: 5 C if r- Sewer Installer: <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 /> •1\Att. a SA--l- S <br /> 4 I KY'" "Cbr ' tk o," rviLloi (YZ x Fee Rec::Ti <br /> v Check#: <br /> Follow all cprcl.i-V1 -from Cui -13-0% o <br /> z <br /> v <br /> Date of staff site visit: y Pie A0Z-3 Init'als of site •' it staff: / T. <br /> it ' I <br /> APPROVED BY LAND SERVICES OFFICIAL: n DATE: X 32 I""l mE <br /> a � cv w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o �' "' o 0 <br /> Z nB0unV rn <br /> --< ILIU' cti = aSIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> ai <br /> Page 1of5 < Q me <br /> Burnett County, WI Land Use Application-Rev 12/2022 aa R-- CO <br />