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LAND USE PERMIT APPLICATION — Burnett County, WI 2 <br /> Applicant Complete All Sections Below This Line 5'7. c w <br /> Permit Types and Fees:(Please,check appropriate boxes) a w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> � <br /> J -, Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °r. c <br /> Filling/Grading $150 Boathouse $500 <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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. C . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> z <br /> Property Owner's Name: FrI(.6''v-v. (,CY'/i m aC- ' A�An'�,cl --C� r&--ky C 1►mr 72 <br /> Property Owner's Mailing Address: pV ?O Y W 14 ,►�► s-f-n/YI IN( ✓4” <br /> i� City State Zip ° 4 <br /> Property Site Address: 12 a1AA C ' ij �� -14 Z c -- <br /> Contact's Telephone Number: -( .• J11 `<9 6L : <br /> Contact's Email: F-t4'15a'-T(f}' 1f coo k-a,tF v .,i io-w- Lf Y` <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °° <br /> @BurnettCountyWl.gov <br /> SE mi.) Ex CSM 6I6 1JoL 24 P i 4y 4 E x CTt4 A d <br /> Legal Description of Property: '8. <br /> Section#: 0 lf Town#: .(21 N Range#: I(p W Town of:__I 4&A 014 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* V. <br /> Tax ID#(1-5 digit number;found on tax statement): to I Cf / e <br /> Proposed Use of Structure/Addition: l V/�i <br /> Anticipated Start Date: f l - (Home/Cabin;Com ercial Business;Bedroom;Deck;etc.) <br /> NIA cn <br /> Building Contractor: Sewer Installer: � <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Pzi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> It),A- t bt UkS,Cd. -6 \WWI \-1001 ittki Dcl <br /> nI r Fee Rec. � <br /> "� � C( n1 Ql 11 p - )21°2/ o Check#: �o7 <br /> 0.� 0 „„A„,,,,, �D b e rZ vt,d 0►� i►' -H-e d I 2 I� z <br /> rti <br /> �C 5 <br /> o <br /> Date of staff site visit: 1[I50`2OZ3 Initi s of site vi 't stafff` I. < l <br /> r F-i so nr�t <br /> Ed <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /2/ /zol3 m 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o w w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 0 C <br /> m ^,c W <br /> Page 1 of 5 < 3 <br /> Burnett County, WI Land Use Application—Rev 5/2023 d 3 <br /> a J..) <br /> g <br /> b <br />