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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> 5 c <br /> J' f <br /> Applicant Compete All Sections Below This Line 7-- <br /> E.". _ w <br /> Permit Types and Fees(Please,check appropriate boxes) - <br /> 0 <br /> Dwelling/Principal Structure $300 !Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/lndustriai Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 'Addition/Alteration to Accessory Structure $150 ; -1) <br /> Accessory Structure(Commercial/industrial) $200 Addition/Alteration to Bunkhouse $150 ` t <br /> �x <br /> ✓ Deck/Stairs/Patio/Beta+sing wail/Sidewalk t 'Bunkhouse °$250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 j 10 H <br /> Fining/Gentling $150 4Boatreouse $500 <br /> Solar Panels(Stand alone or roof mounted) $15Q 'PermitExtension(1 Year Extension Allowed Once) i$100 ! !w <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. r <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. I <br /> *stems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: fie' Pe-fttx 4.tit L Property Owner's Mailing Address: !ZZ$" ' e/('t-t ' t' , �A( �'er" (.A-t'T 5 'Igo a , .� S <br /> Cit.} State Zip <br /> Property Site Address: /2,3 Ip-e-'kt, o r '� _ r <br /> eci ( oe i vE't"" C <br /> Contact's Telephone Number: 6 l 2, -2 qv-Z(o 2,0 i — <br /> Contact's Email: /i+Ii,1 CF 6, 67,at'i • C.d1►---- IV <br /> **If staff has a question about this application, you will be contacted via email. Make sure your email address is �, <br /> legible and your email provider will accept entails from the following addresses:4 BurncttCounty.org and f <br /> (a)BurnettCountyWI,gov "' <br /> Legal Description of Property:L.'t 3 (.iO1 vz..g 'Lo`i ?" <br /> Section#: a Town#: 'Al N Range#: (y W Town of: Seel-4— -Q I f, 1 <br /> *Attach additional page it needed furlengthy description OR attars:a r p ole"of deed OR attach max system ropene page.* Jv <br /> s W r G <br /> Tax ID#(1-5 digit number:found on tax statement): 15" -7 s3`g <br /> Proposed Use of Structur /A ition: ..54C rir,3 ` -ea I c- �� <br /> Anticipated Stan Date: 1liu,not<tthin:Commercial 8nsiness:&Almon:Deek:etc.) <br /> rQ ; <br /> Building Contractor: Sewer installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO LL CONDITIONS LISTE ELOW: <br /> �s 04 l,1A td 5//l?i ,..,... r <br /> Yhv.s+ ✓Ylee- - 4/( .5e S r <br /> r <br /> Fee Rec:1 <br /> Check h: CQ6/1 <br /> ,n <br /> 2 <br /> 71 Date of staff site visit: t D// ��5l)-3 laid s of ite .sit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 C J D--ATE: 4/q�23 M <br /> f C Cr <br /> m CO <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c a o pi <br /> O o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �7w <br /> Page I of 5 ' 3 Ei <br /> Burnett County, WI LandUse Application —Rev 5/2023 f <br /> ' �� <br /> t b <br />