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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line g w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Q 0 <br /> .X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 IN_ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g k <br /> G <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> A <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 . C <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `4 �\ <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: TL~4 t 11✓! Try IC. 5 <br /> Property Owner's Mailing Address: (p'o 33 3 I—!e I stile a kiii P4 �,Tjl/ 59895 i rn <br /> 2 lid 33 l-le IS Ute t? 5L-� to tate Zip <br /> ep <br /> Property Site Address: <br /> • C <br /> I ._ <br /> Contact's Telephone Number: 71$ _�3! -0 ZI <br /> Contact's Email: b C'GZV1 rZ fret (, '+} O � <br /> **If staff has a question abut this application,you will be coip'j'1('/ �1 cted 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 = 07 <br /> @BurnettCountyW1.gov rl j <br /> Sl.J-'NA,) 'ex. N 6 p/ aK0/ex, 1�1330 " d <br /> Legal Description of Property: a i <br /> Section#: I Z- Town#: 31 N Range#: 1 7 W Town of: Lill C C l i1 v, <br /> *Attach additional page if needed for lengthy description OR attach a copy ofthe deed OR attach tax system property page.* 70 n i <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> 10560 tom-, `+ '� <br /> p Car/OO r f w �1 S- I— <br /> Pro Proposed Use of Structure/Ad ition: <br /> Anticipated Start Date: /0 3G'/20 Z 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) . Q <br /> Building Contractor: 04155-Pit1`5 [t C Sewer Installer: / 74 z �\ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY si <br /> A, THIS PERMIT IS_SUBJECT T/O ALL CONDITIONS <br /> cLISTED BELOW: .`�1 <br /> 7 II <br /> Fee Recs./�0"° <br /> Efil <br /> > r- <br /> tn CD <br /> Date of staff site visit: /0/30720 Z 3 Initials of site visit staff: / < m c° n <br /> APPROVED BY LAND SERVICES OFFICIAL: ir,.4.- DATE: I0 �3 rri I <br /> tA <br /> > p ry M <br /> Page 1 of 7 ° N <br /> Burnett County,WI Land Use Application—Rev 5/2023 c2TR <br /> o <br /> xi <br /> m <br /> r <br /> Q <br />