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LAND USE PERMIT APPLICATION - Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line 0 0 N <br /> w <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) \ °' 'S` <br /> Dwelling/Principal Structure $300 "i. Addition/Alteration to Dwelling/Principal Structure $200 CIA <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 51 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> cn U X) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 V <br /> Filling/Grading $150 Boathouse $500 <br /> 4 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. i <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 11 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g ,. t <br /> z <br /> • <br /> Property Owner's Name: /per, yi e cN r^�� o Z ,y , <br /> T � ( a <br /> Property Owner's Mailing Address: c 'PO 01,1 /a f ( ' '/\fir` f/2-4 1 Lay f ar L /< n <br /> -q II� City tate Zip v <br /> Property Site Address: a 9OU(o /(LI r' a.i\I)(A.(' <br /> y, t o N <br /> _ ( c <br /> Contact's Telephone Number: C 1 v� _36-,�/ - ''�3� a <br /> ^ /� d <br /> Contact's Email: (�0L��* r k �I ♦' ��t r • CCU in 0 <br /> **If staff has a question about this application, .. will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °Q <br /> @BurnettCountyWl.gov (yQ <br /> g <br /> Legal Description of Property:7Q//171Cte Ct)o/ei,4 j.4;to V V W I / =. <br /> Section#: / j Town#: 'qt.) N Range#: /� W Town of: J C�c. KS a 1') <br /> 'b cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* eC _V o H <br /> Tax ID#(1-5 digit number; found on tax statement): 3)O �6 c7 <br /> Proposed Use of Structure/Addition: . �eV'`c.3,h'or + d u2 14 U1 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Be ;Deck;etc.) ..C. "C <br /> 0 CSl <br /> Building Contractor: SE fy° Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> Ad&-f-i DA nod- +D ‘1r1.c,ra(SA. (l uu.mb-e.,r o - 6.2ct,vccwis i ri �a <br /> Fee Rec: e200 <br /> o Check#: <br /> m <br /> z <br /> 0 <br /> Date of staff site visit: ' f'i4/ oz 3 Initials of site visit staff:'* ( < w <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: EA W c /� <br /> „EA cc, e i'` ( rJ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o N a I�nnnn11 <br /> z O o rva t1 U U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 ' Q <br /> Pagelof5 i1 <br /> Burnett County, WI Land Use Application—Rev 3/2023 v �` JJ <br /> cn <br /> a <br /> 3 <br />