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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> , <br /> Applicant Complete All Sections Below This Line 0 w <br /> Types and Fees Please check appropriateI M. <br /> Permit T yp f boxes) <br /> b <br /> Dwelling/Principal Structure $300 \ Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 ' Addition/Alteration to Commercial/Industrial Structure $200 a <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ��� � <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g v v <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ?.) O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <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. " <br /> i*Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees.*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> o <br /> Property Owner's Name: 3 C)\,. 1( — c\-' S LS qi - G-e--,( _n r, c� (' o <br /> 0. <br /> Property Owner's Mailing Address: q l v N)Q rtsk r�4 t S 'C..CZ'►1c t�S (�( .5`(0 3`i n i <br /> 1 City State Zip <br /> Property Site Address: I d( 5 .Ste 1 t d N.A. 0 a l 5 ccc'i[�C l ( t 5 (&'O I '`a. <br /> y <br /> Contact's Telephone Number: ` n. ` <br /> Contact's Email: { �r._cit., r- a,'sS,,. (-% U t 7 U cAc, co�- �v co**If staff has a quest n about this application,you will b contacted via email. Make sure your email address is N ,lo 0 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and `s w N <br /> @BurnettCountyWl.gov a, "---_, <br /> r7 <br /> Legal Description of Property: - �� ' CI aG �'� G l �U . <br /> n <br /> Section#: 1,� Town#: L--i i~, N Range#: ( Li W Town of: S c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c x <br /> NI i <br /> Tax ID#(1-5 digit number;found on tax statement): ( 1 � �j � <br /> .- <br /> H <br /> Proposed Use of Structure/Addition: , c� �, ��v 'k <br /> t , • j_ 0�, . -'\— <br /> Anticipated Start Date: ,t�Al (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) 0 <br /> Building Contractor: A- Sewer Installer: AJ A <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 /> • te4- a;u S. -Izu 5 <br /> • If i nd,olx - <br /> p�u.m,b;>n� IS �l��au�.d -I�,r a �-}�-c p� W��cq�s l n cod.e. <br /> x Fee Rec: vd <br /> :p1/101 -1- LQ 1f-),c S9S- yt is -to b.e.. ins-fat/Ltd b j cl IN l Ll Lrl,red PitUn� d Check#: 31..,31-(/ <br /> `L <br /> O <br /> M <br /> Date of staff site visit: $/I V .0Z; Initials of site visit staffs/ r (--" <br /> APPROVED BY LAND SERVICES OFFiCiA l DATE: 0/f ti /ZO23 <br /> a n ,_ Uu <br /> re <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ri w <br /> � w <br /> ff <br /> r .ten <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . <br /> Page 1 of 5 t=i g <br /> 0 H <br /> Burnett County, WI Land Use Application—Rev 5/2023 u -a <br /> b <br />