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LAND USE PERMIT APPLICATION - Burnett County, WI c r <br /> b <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 + <br /> Filling/Grading $150 Boathouse $500 .. <br /> . cn <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `: t <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. '' <br /> �/ o 4 <br /> Property Owner's Name: we �-e. C ig' m p ,d9 . S y L =' <br /> 7 ti1. <br /> Property Owner's Mailing Address: ' r V/T,v�� "� t7I�-� , �n --4 <br /> City State Zip <br /> Property Site Address: 48-- o y NI <br /> 417 <br /> Contact's Telephone Number: '7 ) \! w` . "I / 4 0 — °' <br /> Q.? /t) I2-4 k C 1a- lop i)i�c% -e�}-1 -C'S <eO Y4 J C <br /> Contact's Email: ti �(� `Q � / /�**If staff has a qution about this application,you will be contacted via hmail. IViake sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and I. cm <br /> @BurnettCountyWLgov )J <br /> g P Property: C7I cJ' '`� C�/I�j 2 P3ot, C/G 7(VI y�� 6. <br /> Le al Descri tion of Pro edry' 0. <br /> Section#: 0 (5, Town#: I-)b N Range#: `, W Town of: /6/41-,f}-tvC cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .6) k' =& ' <br /> Tax ID#(1-5 digit number; found on tax statement): j/ 45 t LI <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Cl:5 ..,r-. <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 01eel-- ck11 s ly <br /> ®Nab' 4 hvorfill hob ilic.--"'/) • <br /> Fee Rec: l%LYE <br /> o• Check#:/3 ,57 <br /> m <br /> z <br /> v <br /> Date of staff site visit: 9 'a'i'DInitia s of site isit staff: H� cm <br /> < r �—� <br /> • off' G / 'n c r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: l { -0?/2- `n a ? !1 U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF oU <br /> P ��' <br /> p 0 �` N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> `,-Page 1 of 5 < 3ff <br /> Burnett County, WI Land Use Application-Rev 3/2023 0 "' i <br /> a <br /> 3 <br /> -a <br />