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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> a <br /> e' = <br /> Applicant Complete All Sections Below This Line -- <br /> Permit Types and Fees(Please,check appropriate boxes) a ' <br /> C, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> oto <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> ...f..... 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 1► <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> Filling/Grading $150 Boathouse $500 0 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 go <br /> B. <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> 0 kb <br /> Property Owner's Name: L e.e a!'k 4V vt n S o.- d -r, , <br /> CO k �'s et,. a. b <br /> Property Owner's Mailing Address: a00 t L e(;k 10.-k 6 L V .0w� s3 a�� w. n <br /> n City State Zip ° ` <br /> Property Site Address: aN?-aK LG ri'c ).ee Se, bo4'uc P� ic C r, 11 <br /> 7051A Rn.1 <br /> Contact's Telephone Number: $- ??o ' �- O ci.(Q - 360- lice a r <br /> d <br /> Contact's Email: (0 n. 4- 2 ®,,s-t 4;1, C 0 - I b 5 k &te k e y 4 <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 address: @BurnettCountyWl.gov = °O <br /> uo <br /> Legal Description of Property: V:O 10. Lek k r S.. 6 C o/- _ (to y I, d <br /> Section#: o 5 Town#: 3 Q N Range#: I S W Town of: L eS o(14, ff e c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> Tax ID#(1-5 digit number;found on tax statement): 1 O 2-?- <br /> g - <br /> Proposed Use of Structure/ ddition: $C {e.e h POr'C 1 �d>-d / f(.e s...4 dt � ib 0541 - '' '�- <br /> Antici Anticipated Start Date: G/ /'2 YO <br /> p ,,pp (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) l�1 <br /> BuildingContractor: ' .. g v.'��w V u Jig a S W <br /> YK Y�Sewer Installer: frK kK�� cp <br /> ` v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY mo <br /> r. z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Po <br /> u <br /> i)tv1wt RV St+61S x kA <br /> r11 <br /> rn <br /> 0 No- be u d as a 5letO(1c) SPa(,e I 66 Fee Rec: Z.0i, <br /> Re44eAk,--1- <br /> Check# 35 <br /> Uf ihrm Naci al Coat NIA Ins 4 r unLi peiroli+S <br /> -KG Inseec-krio) -115- yq7-3458 <br /> rn <br /> i" v _1 <br /> Date of staff site visit: 1X,S/ZOZi Initials of site visit staff: '-GIL ., r' <br /> w <br /> 'l 'th7, LP/Ii/ZOZy ro 0 <br /> Ern <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: �� <br /> G � Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD I <br /> 0:, tirtnY <br /> ., , C <br /> C <br />