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DocuSign Envelope ID:6A73DODB-C633-471 F-BF5C-4285F68DA071 <br /> LAND USE PERMIT APPLICATION —Burnett County, `VI N c <br /> -o <br /> Applicant Complete All Sections Below This Line U a <br /> Permit Ty <br /> pes and Fees;(Please,check appropriate boxes) �� j r— <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 G <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Z <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Cll ^ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250114, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 W <br /> Filling/Grading $150 Boathouse $500 t <br /> \,r' 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 applicatio' and fees. `-' <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> 3 <br /> z ok <br /> ` a � <br /> Property Owner's Name: f: Cz,torN.21:ti ,lC'� S(-1,Th g- <br /> Property Owner's Mailing Address: LC1 7 CC.) r)�LA ; (^"t9 <br /> F .- <br /> City State Zip z o4 <br /> . <br /> Property Site Address: Lc--1 1 ( ,� t t v i 1 i r..l N 1. 5f C l '_ ,-?:`----1,-') < 7 <br /> Contact's Telephone Number: 1 `'h- G ')"., L',. i <br /> 7. <br /> Contact's Email: • • z <br /> CP <br /> **lf staff has a question about this application,you will be contacted via email. Make sure your email address is 'N -c <br /> C. "`legible and your email provider will accept emails from the following address: (ii,,,BurnettCountyWl.gov - <br /> cr oO <br /> Legal Description of Property: t; "---._ <br /> 7. <br /> Section#: i t� Town 4: jct N Range#: 7 i,iL W Town of: (I') C tl t-v:r-) ;• -.0 <br /> *attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C N <br /> Tax ID#(1-5 digit number;found on tax statement): ( ja-1(:S — ' x <br /> ul F C <br /> Proposed Use of Structure/Addition: ,S 1(�.V (- l°J' r ,,U r�(( 0/1 r,U_ 0-{` <br /> Anticipated Start Date: /f,� K (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) C <br /> Building Contractor: +_ , ' Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> . <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> r ti <br /> 0 �t tf Ca) St+ Lh <br /> 7 <br /> J rl <br /> CI <br /> � " l <br /> Ch� l d L IM�V l a L pc c' ' Fee Rec: �jrt <br /> rt <br /> 1 it <br /> �202� Check#: JQ7�3 <br /> 04 <br /> sUr (..�Ckir1 <br /> z �I <br /> II <br /> Date of stall site visit: 116t 121.1 Initials of site visit staff: <br /> APPROVED BY I.AND SERVICES OFFICIAI DATF. '/11/ i <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD c W z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o <br /> is S <br /> Page 1 of i �'6-- trini <br /> Burnett County, WI Land Use Application— Rev 12/202,3 ca <br />