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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI <br /> a b <br /> • Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.)w. Addition/Alteration to Accessory Structure $150 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> 11 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> "drOTE:After-the-fact permits(permit acquired after construction has be un may cost up tothree times the normal fee. $ <br /> *Communication Towers, amptng Permits&Signs require a different application form;see corresponding app ication,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> z <br /> Property Owner's Name: ....7... F� 6ME A2.....) -T1 <br /> Property Owner's Mailing Address: a 6/r.,g-' 7/-lom 4 /g.D /Ji$s7� 42' 3%6? <br /> City State Zip E <br /> Property Site Address: ...579- .1‘. <br /> Contact's Telephone Number: 10 7-i-2 '7 — 70 / / -_ <br /> r. <br /> Contact's Email: my eiri rQd nT® A/-!00, C'O m <br /> **If staff has a question about this application,you vill 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 °Q <br /> @BurnettCountyWl.gov ue <br /> d <br /> Legal Description of Property:hi/O W c•-O/6 - 2 i 9" /7 . -` Q/- Mc — O/f oo/ 3. <br /> �Section#: / Town#: 3, N Range#: /7 W Town of: L;pl C Ott/ V, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*3 c34 o <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> h ''. '6\1 <br /> Proposed Use of Structure/ ddition: S-rr) K,A-.j +� 1 a?? r�,j�' H <br /> Anticipated Start Date: 2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) " s V\ <br /> CO <br /> Building Contractor: do Sewer Installer: (W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z S �, " <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW; I� <br /> 0 N074 7172 Le-- u S r a i^ ht.'i-lA q +i 4 0 I /7` ?77mfr1 , <br /> • Fee Rec:/' '� <br /> o Check#: 2p4I <br /> m <br /> z --� <br /> m• °i <br /> Date of staff site visit: I�f/�/w3 Initials of site visit staff: I / ' �- 0APPROVED BY LAND SERVICES OFFICIAL: •C� E: ��/�/�Z3 w "o <br /> in! <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT j r w <br /> Page l of 5 mi <br /> Burnett County, WI Land Use Application—Rev 3/2023 m <br /> cn <br /> -3 <br /> a <br /> 3 <br /> -o <br />