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• LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 5' w <br /> Permit Types and Fees:(Please,check appropriate boxes) F 6 - <br /> C7 <br /> ADwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V4 <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 04 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° .. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> o <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 to three times the normal fee. P <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. o . <br /> Z <br /> O <br /> n <br /> Property Owner's Name: TP�S II U 1M O!1 i� V! He - " ?U <br /> Property Owner's Mailing Address: b 70 C S lQ»y e/ Or (..).)49. 54,- �-<'�- 5[8q3 `- k% <br /> 11� JJ�� City State Zip <br /> Property Site Address: G�i D' S'Ff 49 4l O r e to S k r- , rcts'9 3 <br /> Contact's Telephone Number: 71 S.- a)0 ' I �9 o ° <br /> Contact's Email: ( 4 a i 00 ma,: I. (a wi 0 % <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,t, <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °° <br /> @BurnettCountyWI.gov Clci <br /> Legal Description of Property: S e mot. 4 C Ltd <br /> Section#: I S Town#: '3 1 N Range#: 16 W Town of: rn-e V(c vk v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number;found on tax statement): 3Co S 3 42 �� <br /> y <br /> Proposed Use of Structure/A di 'on: O 141 CP <br /> Anticipated Start Date: 10 ( ai 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: S-Q 1 f Sewer Installer: LA-ht.de IA0 5110)'t �( <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: k...:..: <br /> a/n - au sekL,,i(5 <br /> 00wc1lt' !do-(— -t -ekcee4 a ?eel. At-,fris per SIN .24 466 <br /> C 3 a; (&o4/14 .ae/ 4 ( a W1 i'rcileed ,-3 <br /> M� IS n <br /> x Fee Rec: <br /> P 1‘4rn I q ���� • o Check#: 5af <br /> Vm <br /> a <br /> z <br /> o <br /> W rn <br /> N lGDate of staff site visit: t /i a-/?3 I itial of s' v' it staff: < 1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9113/a3 W CI"v, m E f"t'i n <br /> a Z.B -0 `1 U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o y <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c,rrx? c <br /> Pagelof5 rn <br /> _)J <br />