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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line ] = w <br /> n. <br /> Permit Types and Fees:(Please,check appropriate boxes) p --- <br /> :.:1Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ep <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ��O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c N lb <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. � � <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 74 74• �r <br /> o <br /> Property Owner's Name: . j R A v it• 'S o <br /> J� p. <br /> Property Owner's Mailing Address: ,Q,c/-5.7 d e R Of 0 A^'5r'21 S 5/�j a �' <br /> ol-I V$ C ,J Ci State Zip < <br /> PropertySite Address: 7 e� y <br /> Contact's Telephone Number: ‘12—i?f/� S-. '%�-if 77, 6 ha_ 5 'll ///- 12 e-� . a lA <br /> C <br /> Contact's Email: r A✓z S Ct t m <br /> **If staff has a questi about this application,you will be clontacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BuettCounty.org and °Q rn <br /> @BurnettCountyWl.gov <br /> u. <br /> Legal Description of Property: Pe L. o U L,o <br /> Section#: O t)- Town#: 116 N Range#: �/6W Town of: 0 I -D T v) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 15 O C i <br /> ,! <br /> Tax ID#(1-5 digit number;found on tax statement): /ol-R 7 <br /> Proposed Use of Structur-e/!`jddition: evil I . Lt.,p// AP6o sr jor,c 7-4A-J <br /> Anticipated Start Date: LL A.+ --,K> :IR,4.c i7 157(c{ne/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A / eo&,ec.J d <br /> Building Contractor: Lrl it, L" Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY xl <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> m eek alb 5 e-4-b.t.ks )-' <br /> ( ,)5ee cL1 k ( e ; i <br /> Fee Rec:((2549 <br /> v <br /> Check#: 10= j <br /> m <br /> a <br /> C <br /> I zKA <br /> Date of staff site visit: of it'al of sit visi staff t" <br /> � m { J U,( <br /> APPROVED BY LAND SERVICES OFFICIAL: C,B DATE: Iilcfla3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g fftl <br /> W 0 <br /> ,. <br /> SIGNED.PERMIT APPLICATION IN PLAIN SIGHT m y 0 W _ <br /> Page 1 of 5 < o <br /> Burnett County,WI Land Use Application—Rev 5/2023 v 5` w <br /> LL J <br />