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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> • b <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> C7 ,J <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 S <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 it., F <br /> 0 <br /> Ni o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 lb <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 �` <br /> Filling/Grading $150 Boathouse $500 I/ <br /> rn <br /> AD <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. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g n . <br /> z <br /> 0 <br /> Property Owner's Name: _ ,pt' C Gcvh -W0 7e r- e S V) L-L-C-- °o n I� <br /> Property Owner's Mailing Address: PO 50 ((p llCinbu Vll� 5 I CS . 'v <br /> q City State Zip ° r i k <br /> Property Site Address: a- I?,�1‘ 4 t'��.d,ert Ackic( �N t� \(j* '14% �J <br /> Contact's Telephone Number: (i i`5.> v' — 4 C Li 3 CD <br /> a r <br /> o <br /> Contact's Email: rl e U e e E. Y\of\(16 a sv, (z e%,-}ies ,. CC5 4'J <br /> **If staff has a question about this application,you will bb contacted via email. Make sure your email address is N C <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and a (la <br /> @BurnettCountyWl.gov S�3 0 <br /> Si3 poc:4�1 a P. 0° <br /> Legal Description of Property: Lc L G 5M I4 c1`#5 V 3 1 F3'(0 .?, .,� _, .. 1 3. <br /> Section#: i?5 Town#: 4t0 N Range#: I'o W Town of: OCa. ird T <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f <br /> Tax ID#(1-5 digit number; found on tax statement): 7. 5 4-LH 5 <br /> y O W <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) __hh P <br /> Building Contractor: Sewer Installer: --r..' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ✓flee( all 5e-Ebit,c,4 <br /> 6 * -fir k <br /> L,G A-4-, D veck/f44).i› iv be (a V x Fee Rec: <br /> o Check#:�ci 21/4 <br /> m <br /> z <br /> ter_ �.:_�:. i <br /> Date of staff site visit: 9 1).1123 itials site isit taff: HE-I k 1 a, <br /> o l <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Cl/P7/a3 ci cw, ; ,�;( <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 o <br /> co c ry <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` <br /> Page 1 of 5 ' , <br /> Burnett County, WI Land Use Application—Rev 3/2023 ,.. )_1 <br /> i <br />