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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This LineCL <br /> � <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 in N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 j <br /> N <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(iv)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E , <br /> �. <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. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b - <br /> Property Owner's Name: lrl e <br /> Property Owner's Mailing Address: a2qSq -5& <br /> Cite State Zip <br /> Property Site Address: <br /> p / )AP ��a <br /> Contact's Telephone Number: <br /> Contact's Email: � � t/ tJ abr:_ C Yy!-t L N) <br /> **If staff has a question about thig application.you wil a contacted via email. Make sure your email address is s <br /> legible and your email provider will accept emails from the following address: eaBuruettCountyWI.gov -,, <br /> L nn Ni,.s l/4 Nwi14 0� �`I <br /> Legal Description of Property: b 1`i � R 1 S[ N W <br /> Section#:� T'own ( N l�arege L W Town <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number,found on tax statement): Q Ja CJ <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 8! ¢2 (HomelCabi ommercial Business;Bedroom:Deck;etc.) W \V <br /> Building Contractor: I r Sewer Installer: /,3 A !d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x '� <br /> Not-lb 6 e. LA S c7 -Por A u I.&�P1 1 o L t 7 a T I0 AIStz <br /> � �Q <br /> fg) fillO H W <br /> Fee Rec: <br /> Check#: ?j3 <br /> �e <br /> n <br /> m <br /> Date of staff site visit: 3 Z g Z� of site vi ' aff: fl C!a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: T Z� CD m <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> CD Page 1 of 5 =---_�, <br />