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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5 t td <br /> ii <br /> Permit Types and Fees(Please,check appropriate boxes) i <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I <br /> i d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '' o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° `Q <br /> ' Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> cn <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 tothree times the normal fee. `� <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> O <br /> Property Owner's Name: 6 c:-.-C T h-1...0 Ferri? 1 c 0 R A Sc err* o r <br /> o <br /> o. <br /> Property Owner's Mailing Address: I 300 0 ' irzEsv GT ) '�Gt j M 1r G5 Nip <br /> J <br /> i City State Zip '� <br /> Property Site Address: 12y( I LOW C0_9 L- i t 9 God t V- i 5�{g't l o io F <br /> Contact's Telephone Number: (9 5"2---) 2 l 5 (-]G6 CD <br /> C ` <br /> c. <br /> Contact's Email: 0i"A @° i'uSSC=+4S~C 0Ael <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and g �' N <br /> @BurnettCountyWl.gov cm <br /> t7 <br /> Legal Description of Property: -,. Cv <br /> Section#: I 3 Town#: 39 N Range#: I Li W Town of: RuSk cil <br /> *Attach additional page if needed Jar lengthy description OR attach a copy of the deed OR attach tax system property page.* o x <br /> Tax ID#(1-5 digit number; found on tax statement): )IDg60 "\' d <br /> Proposed Use of Structure/Addition: _ V <br /> Anticipated Start Date: 5/ it I '3-4 (Home/Cabin:Commercial Business,,Bedroom;Deck;etc.) .(A • <br /> Building Contractor: S L I <br /> F Sewer Installer: N A <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ( Pf c U �e-ar S <br /> 2 lick is loca ed r f of -I 75P kJ-4a iv 6/P5 La / <br /> it: Fee Rec: l <br /> 5 Check#: D/ <br /> r <br /> a <br /> z <br /> /I /l ca <br /> tr o <br /> Date of staff site visit: `l/i2/2o Initials of site visit staff: x r —�=r APPROVED BY LAND SERVICES OFFICIAL: � � � DATE: ZOZy W D U u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> vo C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT p r <br /> Page 1 of 5 rf, <br /> 3ff <br /> Burnett County, WI Land Use Application —Rev 12/2022 e, — ` i <br />