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• LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line c, <br /> Permit Types and Fees(P/ease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v y <br /> Commercial/Industrial Structure \ne$300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> x Accessory Structure(Garage,Shed,etc.) -&3s8-' Addition/Alteration to Accessory Structure $150 c FD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> 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 <br /> r <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 m. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. g <br /> F. <br /> 0 <br /> Property Owner's Name: ffQ,ii i iCcM Ce)e_ jI <br /> �/ / �jsJ o o •` <br /> Property Owner's Mailing Address: ��t��ti — cr _�TY�L�� '" � j c) <br /> f�'] 'n 44" <br /> pp�� City State Zi ° "' I- <br /> Property Site Address: 51(f9` SM1'i� �7v �L6s "" ! f l_ <br /> •� o <br /> Contact's Telephone Number: 6/,. t-i 7- V 1 / •1� I <br /> CAW e___/ C d <br /> Contact's Email: J C-�b:�' J. c>'�" =% <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 oo °O <br /> @BumettCountyWl.gov go .� <br /> -� C7 <br /> Legal Description of Property:LOT_._l �} <br /> _CSiv4 V Li P l 3 (I N(�OV LOTZ') (W/fS� # 3�/5 53O) �. \N <br /> Section#: Town#: 33 N Range#: 15 W Town of: L.a Foll e t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �\ 0 P3 <br /> o 5 <br /> Tax ID#(1-5 digit number; found on tax statement): 929 i <br /> N <br /> Proposed Use of Structure/Addition: W A <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) V NN <br /> ,� <br /> Building Contractor: Sewer Installer: z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ----- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 SAc15 /10A 749 6e uSc1 4V` luA4a0 414L/1/4/70n. <br /> 0 S%e)c/S / M q/1 S e fl Q G/4—S,, <br /> M Fee Rec: 4dDD-41) <br /> n. <br /> v Check#: �2 1 <br /> m <br /> z <br /> z <br /> o 1 <br /> Date of staff site visit: 3�/2[ff s// 3 /�f In' ' is o site visit staff: /7-i < 6f—�rJ� <br /> ,L P b <br /> Uu <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ✓C��ZDz/ m <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 0 CD <br /> N oz <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> �`` w <br /> Page l of 5 ffi <br /> Burnett County, WI Land Use Application-Rev 3/2023 v Lk <br /> z.. <br /> X <br /> -o <br />