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10 <br /> CD <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a 9 ro <br /> Applicant Complete All Sections Below This Line �! <br /> a <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <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 $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °- N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r I <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> ;v• <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> CD <br /> •o <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 /> ►o <br /> Property Owner's Name: K_ ,, _ a� h N� Cl� C h c i S iCS r� f n o �D <br /> Property Owner's Mailing Address: -7 Q-1 ( 1 n N 1554 3 L <br /> City State Zip 4 <br /> Property Site Address: �t" GiPG gE'CLr fir CC- 111A rya 11 .C- 5yt241, c N <br /> Contact's Telephone Number: 1 (0 3 - 3 3 1 J6 a a a <br /> d <br /> Contact's Email: K e-C- 0 a 3 q 0.j CC)A <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov R. °° N <br /> w v <br /> Legal Description of Property: L-C+ n-I' yO!4q!� t-eA-V i �et e o ry <br /> Section#: Town#:_qp_N Range#: (5 W Town of: SCLCj h <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> ` o <br /> Tax ID#(1-5 digit number;found on tax statement): 1 344 O <br /> d <br /> Proposed Use of Structure/Addition: Cw bin <br /> Anticipated Start Date: �al <br /> I�GG � <br /> i JJa Ne fomelCabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: errlry Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> Q DweutNC, va-r TV ExceFd 3 BEutioo S PER 5.4�►-75 -,3'f. <br /> Q 6*6b A) T <br /> or o 3E U"-P AF, HABi>AT7on/. Fee Rec: <br /> z Check#: <br /> r <br /> C <br /> Date of staff site visit:Val'o- Initials of site visit staff: i)_R `L X <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 DATE: q 7,f jZo2 5- 0 CD <br /> -� CD N <br /> UPON APPROVAL: APPLI T MUST POST COPY OF w C ' <br /> �D � N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> m Cn <br /> Pagel of 5 <br />