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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line 0 . w <br /> Permit Types and Fees.(Please,check appropriate boxes) d r <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r0 a <br /> Filling/Grading $150 Boathouse $500 cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> m• <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o . 1 <br /> l o 1 <br /> Property Owner's Name: Jo,- �% re t�Ic7 1c =' t <br /> 1p /!� oo • <br /> Property Owner's Mailing Address: gO i e C i' / Ri CL PA-n v f y w / S f�g3 0 g. n <br /> / City / State Zip cn <br /> Property Site Address: S4-°"1e- o y <br /> C <br /> CD <br /> Contact's Telephone Number: 2 I S )I/ -70?/ °' <br /> e <br /> Contact's Email: 6 erc- .J .fie n) — a 3, A4c,.,"l . cc `° <br /> **If staff has a question about thib'application,you will be contacted via email. Make sure your email address is N ,.d <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0° <br /> @BurnettCountyWl.gov w <br /> Legal Description of Property: C.Chi t/ZZ P.4 7 <br /> Section#: /c( Town#: C U N Range#: I 4 W Town of: CD a (k' I Q✓I d c/) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* x <br /> Eilial <br /> Tax ID#(1-5 digit number;found on tax statement): 2.-a 0 dProposed Use of Structure/Addition: 5 F{e cke dAnticipated Start Date: Se P /- is- E ' 2 3 (Home/Cabin;Commercial Business;;Bedroom;;Deck;etc.)Building Contractor: Sewer Installer:AREA BELOW THIS LINE'FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �,z <br /> THIS PERMIT IS SUBJE T TO ALL CONDITIONS LISTED BELOW:v�` ��� 11 H✓rt an t b,47, can <br /> g, Fee Rec: <br /> Check#: _19 • <br /> Date of staff site visit: glaq /.23 Initial of;e v' it staff: PE r Q. <br /> APPROVED BY LAND SERVICES OFFICIAL: , I. DATE: 5 1 I 2 3 `z.D ' <br /> Trig a t... Y y Y <br /> csi <br /> Pagelof7 c 0 o <br /> Burnett County, WI Land Use Application—Rev 5/2023 w R <br /> VII <br /> a ._ vs*__— <br /> c Cr" <br />