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b r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> b <br /> N lJ <br /> Applicant Complete All Sections Below This Line °o a t' <br /> Permit Types and Fees(Please,check appropriate boxes) liz e <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 „ <br /> , <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 l, <br /> '....... Fib <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C <br /> h Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 v) <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. CD <br /> o l l <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 Z <br /> 0 <br /> .11 <br /> �,d,�`IS C Y• N <br /> Property Owner's Name: Ro )-1„, o <br /> I � al. i <br /> Property Owner's Mailing Address: £ '7 ta D-t + I S I I< h c t,'"e Ste``t l'`�3'S-1 93 O TT. tA <br /> (� /fir --S City _State Zip W <br /> � (v /-��.' <br /> Property Site Address: (, ..%)I. Is'. LA Lae" t C i. S �V� 3 3 <br /> o �' <br /> Contact's Telephone Number: i/S~- . 13 --//)S 4 a0 <br /> Contact's Email: b Cr7Lv`l S'cot'1 f 1 i(,0 (0) 6-/4ch 1. ' It Jt^'-‘ CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,.o O <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0. °Q <br /> CIO <br /> Legal Description of Property: ,�� Sf e X Ei )2 A . <br /> ]� /� N <br /> Section#: 2,� Town#: y 0 N Range#: l 6 W Town of: Oc,,x/�,,l�� <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): /3(c, ie <br /> c7 <br /> Proposed Use of Structure/Ad tion: )0t /t('� <br /> Anticipated Start Date: y 'A (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -, ..C - <br /> Building Contractor: & Ili v1 1..,K CTr j^ / ,<eiewer Installer: y D <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d f.c____ <br /> v, <br /> 0 A <br /> Ut+ cat st4-ba s < <br /> w <br /> Fee Rec: - <br /> °z Check#:if ecrney <br /> r <br /> < <br /> x <br /> m, <br /> Date of staff site visit:yin ZOZ1f Initials of site vi 't staf 4' 61./L, v r �I <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> DATE: `'l/I / 2[7--)771— 3. W !1 u u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> m <br /> v0 o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTpao <br /> _ E, tz , <br /> Page l of 5 CD <br /> bill <br /> Burnett County,WI Land Use Application—Rev 12/2023 (...L J� <br />