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LAND USE PERMIT APPLICATION —Burnett County, WIits <br /> a <br /> Applicant Complete All Sections Below This Line <br /> a � <br /> Permit Types and Fees:(Please,check appropriate boxes) a d a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 UJ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Z <br /> 0 <br /> Property Owner's Name: Pa.v t Z w CS C_I ho f e✓ o <br /> Property Owner's Mailing Address: C) 6' <br /> ,p y� City State Zip ] 0 <br /> Property Site Address: 2_7S 2). ! r -'� ( R�Lq <br /> Contact's Telephone Number: <br /> s t7 <br /> Contact's Email: t9Z w 2C y�hx �-° <br /> CD <br /> **If staff has a question about this applicati n,you will be contacted via email. Make sure your email address is N ro V\ <br /> legible and your email provider will accept emails from the following addresses:@BumettCounty.org and <br /> @BurnettCountyWI.gov b N <br /> � N <br /> Legal Description of Property: o! 31 2Cnn go ?. l/,/ <br /> Section#: 3 ! Town#: +0 N Range#:__U_W Town of: ��c-�[ b on <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* x <br /> Tax ID#(1-5 digit number;found on tax statement): J 9 5 <br /> Proposed Use of Structure/Addition: J / <br /> H <br /> Anticipated Start Date: Q (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) c � Xj <br /> Building Contractor: /t e✓cn Tit n S$p­ Sewer Installer: -fr-y s -,C <br /> z p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 2 No4 be u cy <br /> O <br /> �2 S a; Fee Rec: <br /> co) can r �o Check <br /> I m <br /> Date of staff site visit:12 2,o2 Initials of site visit staff. 4, D <br /> APPROVED BY LAND SERVICES OFFICIAL: 6` D DATE: I Z 3 ZOZ <.si <br /> si C <br /> `° ^� <br /> Page 1 of Co ® � <br /> Burnett County, WI Land Use Application—Rev 5/2023 9 � <br />