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LAND USE PERMIT APPLICATION—Burnett County, WI c <br /> Q i <br /> b <br /> Applicant Complete All Sections Below This Line 0 <br /> co Permit Types and FeesfP/ease,check appropriate boxes) n t <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ' '•b <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V <br /> ✓ Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �q <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i j\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 b <br /> Filling/Grading $150 Boathouse $500 <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. _ 3 <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a '(�" <br /> o <br /> Property Owner's Name: ' N,C" cbMiL\'ev1 8 <br /> 1 '1 '. 6 <br /> 1 76 �� B <br /> Property Owner's Mailing Address: ���;� �w ��'��-� �I"I�X,� " � <br /> \/ City State Zip E <br /> Property Site Address: } o i <br /> Contact's Telephone Number: b 101- ��i '-737 „ <br /> e <br /> Contact's Email: V+► VVe�� ` <br /> **If staff has a question about this`n placation_you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: BurnettCountyWI.gov <br /> s• <br /> G! <br /> Legal Description of Property: o c.4 S1 r,..j -1 J .4. U c'3 ct� V; I(a€Q L di- 3 0 <br /> Section it: j Town#TyO N Range#: I -5-- W Town of: lac-Kiro,"‘ 0 ! <br /> , <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* "C <br /> Hp n <br /> Tax ID#(1-5 digit number,found on tax statement): 3-6 � I I., � <br /> Proposed Use of Structure/A 'tion: &a ,��SA .�. , rG -� '� <br /> Anticipated Start Date: "4 2 0 7 ( ome/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> j d I� <br /> Building Contractor: I\C 1 t- Lpy'�1w'14 ci/pile Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 8 <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> , <br /> N o\- kb kpt., . 'Par \n nax, A-c am U <br /> Fee Rec:�� <br /> Check#: if.( '7 2 <br /> tt <br /> n <br /> n <br /> rri <br /> I l J <br /> Date of staff site visit:—7'1$1101frk Initials`` of/ site visit staff: u L- / --'-'—-- �,nf <br /> APPROVED BY LAND SERVICES OFFICIAL: � l/ �/i DATE: li trI��f CD W C 110u U <br /> <.3 r" <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o N gTO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD C N G <br /> Page 1 of 5 3 <br />