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cr <br /> `0 LAND USE PERMIT APPLICATION — Burnett County, WI <br /> 0-. b <br /> _ Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees(Please,check appropriate boxes) n <br /> C7 )t) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> _ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <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 /> nT • <br /> Deck/St irs/ at' /Retaining Wall/Sew Ik Bunkhouse $250 <br /> riveway &Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> WWW <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. '41)— <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. it <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> � a z ! <br /> Property Owner's Name: F' RE/►i /�F 8 N A It <br /> /� � d. % <br /> Mailing f_� d &2245TS l/A'-�1r`� �/fw, r-M j�j7i2 � n r <br /> n. <br /> PropertyOwner's Address: �. <br /> City State Zip <br /> Property Site Address: 3 y7 L Af t._(L d-/L-6 I t9�20 < J <br /> ( S2_) 9 3 - .S .Contact's Telephone Number: ,/ <br /> Contact's Email: 1 /'4'-5 i C e0A-s-rote V1 T :% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 <br /> 0 aq <br /> @BurnettCountyWl.gov cc N lv <br /> LO7 Z- 4 .3 ��U f 6/ .9 o <br /> IN <br /> Legal Description of Property: re N (1\ <br /> Section#: f a j Town#: * N Range#: 1r W Town of: CO� cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> — <br /> Tax ID#(1-5 digit number; found on tax statement): 3 0-6 L- N r� <br /> .--3 — 1 <br /> Proposed Use of Structure/Addition: j / /if/Z/p T it" S/P€fiJ' . „� <br /> . <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _ N <br /> Building Contractor: 'i T J & A-CIE Sewer Installer: 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> pzi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> U" <br /> x Fee Rec: <br /> f `t <br /> c Check#: 24t4A/ <br /> m <br /> Date of staff site visit: I`IZI 2-; Initials of site visit aff: ^ :_ <br /> a CDM <br /> APPROVED BY LAND SERVICES OFFICI ATE: 11 N2023 :< = .....I <br /> fD [� <br /> A <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF `� a _� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w cc1511 <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 ., LL- JJ <br /> a <br /> K <br /> -o <br />