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CIO <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> _ Applicant Complete All Sections Below This Line <br /> CD <br /> Permit Types and Fees�P/ease,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 pp-� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200ii�v� O <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 /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk I iBunkhouse $250 <br /> Driveways/&Campground Structures $125 1 jWl State Statute 59.692(ly)Structures $350 r" <br /> 0 <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 1 1 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 /> ro <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. <br /> z <br /> 0 <br /> Property Owner's Name: <br /> 0 <br /> Property Owner's Mailing Address: 7 M' V f✓ ;5 ' ' 1 Il i'1{ 'Dr i <br /> _ City State Zii <br /> Property Site Address: ! f-) J Pic.� 7. o <br /> Contact's Telephone Number: b ( 7—'2 - (j Z -I"eq ° <br /> Contact's Email: a�-OAN i k I e '' G�1 1 1�1� <br /> CD <br /> **If staff has a question about is application, will be contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and <br /> @BumettCountyWLgov <br /> n �, d <br /> Legal Description of Property: f"C k (0 LGU � �� � �• <br /> Section#: Town#: L4 0 N Range#: 1 u W Town of: a, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c <br /> Tax ID#(1-5 digit number;found on tax statement): CA <br /> _1 1 H <br /> Proposed Use of Structure/Ad ition: r(` 'C ' d �'tC't <br /> Anticipated Start Date: (� (I7 f'I(, k(Home(C-a-b-ij Commercial Business;Bedroom;Deck;etc.) I O <br /> Building Contractor: Sewer Installer: A/ /A -Q <br /> AREA BELOW THIS LINE F R LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �4H - mow, <br /> Fee Rec: <br /> c Check#: <br /> o `_ ----- <br /> Date of staff site visit: 7 Z Init' s of site vi ' aff: /► < <br /> y � <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z Zo Z.e7 z.� CID = � <br /> m N iJ u IJ <br /> UPON APPROVAL_: APPLICANT MUST POST COPY OF o 551 <br /> _ _ <br /> APPLICATION IN PLAIN SIGHT <br /> 00 <br /> SIGNED PERMIT APPLIC <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> a <br />