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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Please,check appropriate boxes) 1§ <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <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 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> XDeck/Stairs/P ' ing Wall/Sidewalk Bunkhouse $250 ,. RI % <br /> Driveways/ Campground Structures ) $125 WI State Statute 59.692(1v)Structures $350 o j <br /> Filling/Grading $150 ,Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 . <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. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. , v <br /> z <br /> Property Owner's Name: ) 1� i{'h, c re w J-. D c t LA 1 o '` r/ <br /> ir <br /> Property Owner's Mailing Address: Po 6 o x DO N b it 9 <br /> 1 / k'- . S y 0 D 1 n 4. <br /> City . 'State Zip k' , <br /> Property Site Address: n. �-6, i ' kcf— � t't' b u- e u.rs L41-ity.f q re, t l,Ncr, roeg o y v <br /> O c , <br /> Contact's Telephone Number: 7 i,5-- 1e q^ 33�6 lle log(Q` a <br /> t u d <br /> Contact's Email: 5 p u cI c l y ) 1 t' i g YA h ob f CO rr' ' ..S <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 tl° <br /> @BumettCountyWl.gov a°c <br /> Legal Descri tion of Property: L I W,Vl 21/9 Lis Vol ;7 P3Gt7 R. <br /> Section#: o S Town#: ?D N Range#: 1 to W Town of: (j h,k L x IUd <br /> *Attach additional page if needed for lengthy description OR attach <br /> La copyo of the deed OR attach tax system property page.* H <br /> Tax ID#(1-5 digit number;found on tax statement): 35 d <br /> Proposed Use of Structure/Addition: <br /> OeCG H <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) c� p )- <br /> Building Contractor: Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z ~� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ,„ Pfiiee Q1/ sue he i <br /> Fee Rec:1Ab -- <br /> o Check#: 62a� <br /> m <br /> z <br /> z <br /> b2i 1 v <br /> Date of staff site visit:(/ d-3 niti s of ite isit staff: iik% m <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE25/?4/2-3IDID Q. <br /> llU u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ` -, C.) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . <br /> Page 1 of 5 m. 4-4 <br /> Burnett County, WI Land Use Application-Rev 3/2023 v <br /> 3 <br />