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LAND USE PERMIT APPLICATION - Burnett County, WI cr <br /> �. ,- N <br /> cn Applicant Complete All Sections Below This Line o w <br /> Co I <br /> Permit Types and Fees(Please,check appropriate boxes) C7 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C 6 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o V,) * <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 W 0 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `q <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 • <br /> *Items not listed above will be treated as accessory structures,,such as:pergolas,landscaping,etc. g' "' <br /> )' ,,; o <br /> Property Owner's Name: , t- <br /> ) V1 � L� 0 U 1� , o >J P <br /> p .e4- <br /> Property Owner's Mailing Address: 13 14 U td e St eQ ( I++ 09O r , r <br /> CityState Zip ° <br /> S `� <br /> Property Site Address: � V A '. v 01 kp <br /> o N <br /> Q n. <br /> Contact's Telephone Number: �� g 3 0 � 3� 0 Q � <br /> 1�--1` <br /> Contact's Email: cpoo N, / Y At, c Q , l..,0 ,,,, <br /> eD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b ., <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °> °Q <br /> @BurnettCountyWI.gov ao <br /> �J �' <br /> Legal Description of Property: F`'' �� I O Jy S ll y t 0.) �1 9.• <br /> Section#: )J Town#: q 0 N Range#: I 1 W Town of: SU,4a- vi <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N o ' <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> ►853. ' <br /> Proposed Use of Structure/Addition: .,��t ,0 f- ' s <br /> Anticipated Start Date: (J C- + y If)F - 3(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Q , <br /> Building Contractor: Sewer Installer: QO <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> K(le&F <br /> a II se-j-bc,{/i3 <br /> Vtrt- .D1 jutiltAl it hJ,, 41 <br /> O 3 f t/e4R.e kg eo[ boc.+ kwtcti l-o be_ c1 s c i..s scJ tV+'t <br /> 2 � Fee Rec: b= <br /> Cale CCU► s rVoch'c)�l ( C a/ /l4j b 12.�I /?3 <br /> ' P 'o Check#:� <br /> m <br /> Z <br /> . o <br /> mi <br /> Date of staff site visit: I t I 9/ � itials f site visit taff: / < L J <br /> n r r <br /> APPROVED BY LAND SERVICES OFFICIAL: E DATE: /�gr a v, a U u <br /> cil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m a o o <br /> Page 1 of 5 < t <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 a <br /> a J <br /> 3 <br /> •o <br />