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CIF t" <br /> LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 1 c , <br /> Permit Types and Fees(Please,check appropriate boxes) n <br /> v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 0 <br /> oh Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> eck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br /> $250y o <br /> < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ; <br /> o It <br /> Filling/Grading Boathouse $500 1 <br /> y <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? i <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. s <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. S - <br /> z Nk <br /> Property 94 es=s- ame: , <br /> ' Property Owlages44ailing ddress: 01,51C1 0 ud a klE n _5 j7 2 n 1 <br /> ow IN V( City Stdte Zip ° X , <br /> Property Site*dcIw.,: < <br /> A �/� ,� e2_________ � N ^ <br /> ' Contact's Telephone Number: ' c3 8 ci , , L'I->` <br /> C o1 CepOU45 cam'p0L d <br /> ' Contact's Email: � ��.��� .tO `pet t� C,v`Yl <br /> **If staff has a question ab t ' ls application,you wi 1 be ontacted via email. Make sure your email address is ,0 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @BumettCountyWl.gov 1 <br /> Legal Description of Property:P P rty:L1:4- I C5rvi Li lQ 145 V o21 P 3o 6 Doc li 41 8 0 <br /> /I m <br /> Section#: S Town#: ii a N Range#: W Town of: 09%1/1 lq#i- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ''' ' c <br /> Tax ID#(1-5 digit number; found on tax statement): 3 a• 2 \ d <br /> J5 L <br /> %Proposed Use of Structure/Addition: u' - y S J lb G <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) r <br /> Building Contractor: Sewer Installer: 0 '� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> j rfl e4 RE/ 5e- 1, <br /> 6)11w1- -� It,,. 4 ,er <br /> 'ircJ^'x4 <br /> g Fee Rec:"tic" / <br /> o Check#: 1 7 7// <br /> (�/ rn <br /> y EDate of staff site visit:(/` �a 1 �3 staff: iir <br /> a. <br /> APPROVED BY LAND SERVICES OFFICIAL;,izsof,,:irsit <br /> < a, <br /> ^ DATE:U/P''/a' -3 y Q. >. <br /> /• <br /> 4 CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z y <br /> SIGNET) PERMIT APPLICATION IN PLAIN SIGHT <br /> g (A) 0 <br /> Page l of 5 < ii <br /> Burnett County, WI Land Use Application—Rev 3/2023 v �L <br /> a <br /> 3 <br />