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LAND USE PERMIT APPLICATION — Burnett County, WI ro <br /> b <br /> Applicant Complete All Sections Below This Line C (Oa <br /> CD I <br /> Permit Types and Fees(P/ease,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 o f� <br /> . Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i F <br /> ., <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> \( Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> 7a <br /> Filling/Grading $150 Boathouse $500 up <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R. i ,, <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. »• rz <br /> o Property Owner's Name: . ` ��� j2 fC�— �y . ° t <br /> 0 <br /> 0. <br /> Property Owner's Mailing Address: r,Cj 9 CO. a cf•� lfp.,h.S•-'ice. Ay- S7 ' n <br /> City State Zip ° E `'\ <br /> Property Site Address: / y 1 A �S ►e�2 j�^� �e/7 < N N <br /> Contact's • <br /> Telephone Number:17 ' c/ <br /> / 5 3 0. <br /> C7 <br /> w• v, <br /> Contact's Email: L./q 4il c71101.Cre a g/ 0- A-h CO • Corr' == c <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and R. <br /> @BurnettCountyWl.gov vro <br /> 0. <br /> Legal Description of Property: Liz.... ,A j¢ � a <br /> 4,� . <br /> Section#: Q 1 Town#: 3 ?N Range#: 17 W Town of: L/MO L,/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* z.) <br /> yr� e <br /> Tax ID#(1-5 digit number; found on tax statement): /0 g r.. <br /> Proposed Use of Structure/Addition: C% <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroo , ec • tc.) <br /> Building Contractor: Sewer Installer: C) <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 /> 0,lee I AS 5 lcs <br /> 0 tv,i- .�i „,-,, k,b, . , <br /> // s y ,f •?C( <br /> Ovr.-6.45,0. 144444)0rr /I 5; h nee( Qs D ' Q(e,ri, e 5 n M _¢ 0 <br /> 40 26i-- $C G k or �o�d l��1 a 3 Fee Rec: �q�� <br /> '7/ <br /> o Check#: /(} <br /> r <br /> r <br /> 2 1 <br /> Date of staff site visit: e IXb3 it' is f sit vis' staff: ill. v r- Ind <br /> th <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �r I/o`J t c c vt <br /> v <.CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF - oo `,' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �` <br /> tr• CD Inn. <br /> rrC <br /> Page l of 5 • LL JJ <br /> rr <br /> Burnett County, WI Land Use Application-Rev 3/2023 <br /> a <br /> b <br />