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Om./LAND USE PERMIT APPLICATION — Burnett County, WI <br /> c.Applicant Complete All Sections Below This Line 5 w <br /> Permit Types and Fees.(Please,check appropriate boxes) a- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,s6 O 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 =V <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 << r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o Of <br /> CIO Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 A Permit Extension(1 Year Extension-Allowed Once) $100 5I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ` <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a . <br /> Property Owner's Name: Ej p„Q�( 4f �! .0 <br /> p n,_rl�,�� /� �p� 0 <br /> Property Owner's Mailing Address: N10 WIC' ' A'M ) QjL.; 1 1 g 9 E n a.0 <br /> �� `_�S City 1 tat; Zip < <br /> Property Site Address: 7 @NIP ~ 1 �I ,S' 1 �� 3 •c '6 <br /> Contact's Telephone Number: J' 206- Lv n <br /> -a1 Contact's Email: ' 200‘n�Y-P , COr'1CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> o <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and , 0° <br /> @BumettCountyWl.gov cit <br /> .6 ✓S i t7 <br /> Legal Description of Property: �i ( �•� 1� 1Jtt �L '" � k• <br /> Section#: 'J� Town#: L O N Range#: i'1 W Town of: V N ION <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W ' x <br /> ismr. <br /> Tax ID#(1-5 digit number;found on tax statement): 25L{ <br /> Proposed Use of Structur dditio : C <br /> Anticipated Start Date: (I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ...t <br /> Building Contractor: 01•0* Sewer Installer: I�/� G M <br /> z \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> O r'/w4 G It 7e+b4 t 0/yd. _6( A ' �a4,,..,,4 <br /> x Fee Rec: <br /> d Check#: <br /> rn <br /> r <br /> a <br /> z <br /> 1 CA <br /> vrri ��l <br /> Date of staff site visit: Io/s/a 3 Ini 'al of site v' t staff: I J x r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 V) CD co n'1 <br /> y S.7 '� <br /> CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z o o v, E <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT K w C <br /> Page l of 5 < m <br /> Burnett County, WI Land Use Application —Rev 5/2023 u L. J� <br /> y <br /> a <br /> b <br />