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LAND USE PERMIT APPLICATION—Burnett County, WI a ro <br /> N N <br /> Applicant Complete All Sections Below This Line a. A. <br /> `&' <br /> n. <br /> Permit Types and FeesPlease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v` p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 II- <br /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> t. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I' <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. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g" z <br /> // o <br /> v <br /> Property Owner's Name: ,,-- '2y'G.-/— & ( G Q 1 o <br /> (a. <br /> Property Owner's Mailing Address: -j 02- S• Zt,dl s --• Fran r r,l PIA) XS 37/ .. , Fr <br /> City State Zip 4 Y <br /> Property Site Address: .3 0.7 ;3 5-/e-E., N w 1 33— 176.-01 U..✓1 LJ / o v <br /> c <br /> Contact's Telephone Number: 6,/ 2 37 _ q 3 _S- e <br /> Contact's Email: r -e-`1' 0 L&-rse r\GO r S kev�C-}-1 ti►k YVk A - CO Wvk <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N - <br /> legible and yourB ern provider Il accept a�1s fjom t>�e�ollowing address: @BurnettCountyWl.gov �. °C <br /> 'jj 1/' / `J n (r <br /> Legal Description of Property: ill hi taffii Y r e y l.(Se f PR +x Ter u t It 5 d <br /> /Jav, f,�7 <br /> Section#: aZ Town#: it/ N Range#: �� W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* (- 11' <br /> I N o <br /> Tax ID#(1-5 digit number;found on tax statement): ' (� _� \N 3 d <br /> Proposed Use of Structure/A ditio�: O vi 6Q Fole ,�t�,°% l - ilfg4►� l ry' �l°uLJ -i <br /> Anticipated Start Date: L/ZZ 2 Z� (Home/Cabin;Commercial slness;Bedroom;Deck;etc.) \ , <br /> Building Contractor: ee-rieve C °y�f�✓ ,..4.,,,,r<. Sewer Installer: ad s-ea„/ e.-tr NAREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Piz V1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: E z � <br /> p( ,7L. 6 e. U S -(`r A u wt a-h A4b/AQ7 d, <br /> Fee Rec: 5neD <br /> co <br /> ° Check#:5 7 R'9 <br /> n <br /> m <br /> to <br /> m <br /> /�Date of staff site visit: S ZD Z5/ Initials of site visit O f / ' <br /> TE: .JArze a bill <br /> APPROVED BY LAND SERVICES OFFICIAL: D <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF cp <br /> m -lb nil <br /> tJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> Page 1 of 5 m .. ,- <br />