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LAND USE PERMIT APPLICATION — Burnett County, WI e~ <br /> 1 <br /> L <br /> b <br /> Applicant Complete All Sections Below This Line ' w <br /> Permit Types and Fees(Please,check appropriate boxes) t� <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 o U1 <br /> `Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..G O <br /> ,, cessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> ad Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 1 , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> vi <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 tothree times the normal fee. 1 <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. ' z <br /> z <br /> ./ <br /> o <br /> Property Owner's Name: t c Ill/ CIL C,k' 11 T R. o `� <br /> / )i lY3 (4111Sflei i 4 (�s�Pf 1 SY8`� b Q._ <br /> Property Owner's Mailing Address: !' 0. n <br /> iI j City State Zip ° "' <br /> y)Property Site Address: I t C d -Co/ ) l 775 &tier pp o N <br /> Contact's Telephone Number: 1 t 7/ c9� _ °- <br /> Contact's Email: l4e/I y l nc I l l%")_.0 ci =% <br /> **If staff has a question about this application,you v4 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 00 <br /> @BurnettCountyWl.gov 1 <br /> d a <br /> Legal Description of Property: (at' 2 CS/" ci,6 1 V P/ (;26;) P/ 7/ 3. <br /> Section#: Town#: 3"3 N Range#: )Y W Town of: De(,Je <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 ssttatementt):Q('13fo I '3 �/ <br /> 0 CP <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) % E , <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z w <br /> THIS PERMIT IS S BJE T TO ALL CONDITIONS LISTED BELOW: _ <br /> Se" c ' <br /> a of ca hui(044 a 61 :4; <br /> Fee Rec. -C <br /> o Check#: ((oil <br /> m <br /> z <br /> o <br /> Date of staff site visit: I I.J 'a3 I ' ials f sit • it aff: HY < Q �`--�' <br /> / riicn � <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ID1kjl 3 EA < co m l� t <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 0 <br /> z CD C ^) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT M 3` N <br /> • <br /> CDC f <br /> CD <br /> Page l of 5 a u u <br /> Burnett County, WI Land Use Application—Rev 3/2023 v �L J, <br /> a <br /> i <br /> b <br />