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LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and FeesfPlease,check appropriate boxes) Q <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <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 <br /> Accessory Structure(Commercial/industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk IBunkhouse $250 <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(ly)Structures $350 r <br /> Filling/Grading $150 18oathouse $500 Cn <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 /> -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 /> z <br /> 0 <br /> 1 N <br /> Property Owner's Name: Rolf- Q f o D <br /> flProperty Owner's Mailing Address: C I� 3 w <br /> Q r , City State zip <br /> Property Site Address:_ O �J �'-UGC-C_ 13 tZa r T C- e— <br /> Contact's Telephone Number: .2 , 17®q • (� b 3�fj ( i�i�1l/�C(O �' <br /> Contact's Email: ! S I Q, i17L5 ee n Q f co , Co m <br /> **If staff has a question about this application,you will be contac—ted via email. Make sure your email address is N 'L <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0_ °Q <br /> .} _I J 0 >o <br /> Legal Description of Property: l��/ 1 6y-sa—! 6-oar ACT`lam - 1l��Q 1t r d N <br /> i ' <br /> Section#:S I Town#: �N Range#:�,—W Town of: �ac YSn n V) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* A <br /> Tax ID#(1-5 digit number;found on tax statement): < 3 4 jq- <br /> d <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date:! (Home/ mmercial Business:Bedroom:Deck:etc.) ` l� <br /> Building Contractor: ,1,(aYI�CI b��. &� Sewer Installer: (`rO tteo-it r�'lCrA UGt n/1 q <br /> n <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Z" z o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Z <br /> d <br /> © McET 4LL 5*MgcKS. ct3tric4L YO Fodr rfeo9R MoPrRrY (,/NE SE7F40r. <br /> Q D�.)ELLla/Cr nloT fa EXCEED 3 54kwke KxS HER Mill -Z5 -33. <br /> Q IRED AMT ID SC' u.sED FOP, t4~V "817'1r1WV. Fee Rec: <br /> z Check#: <br /> r <br /> �e <br /> Date of staff site visit: 9 Initials of site visit staff: 06 <br /> APPROVED BV LAND SERVICES OFFICIAL: 1 DATE: Y/zf/z0Z-5- <. <br /> m ^� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD ' <br /> Page 1 of 5 <br />