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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and FeesiPlease,check appropriate boxes) ° t <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 /> CD <br /> Accessory Structure(Commercial/Industrial) $ 000 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk I IBunkhouse $250 ° <br /> Driveways/&Campground Structures $125 1 jWl State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 Un <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 /> *Communication Towers, Camping Permits&Signs require a different application form,see corresponding application,and fees. b <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: Z <br /> o <br /> 0 <br /> Property Owner's Mailing Address: `- `'l 0c) 3-Vy k,r et, 5 . i MX "5,5 y( <br /> City State Zip ' N1 <br /> 7— <br /> Property Site Address: 3li 3 F�cYilrot in e- F,.A• 1 SVct• , W r. sw6c13 0 <br /> C <br /> Contact's Telephone Number: (o 1 Z— Z.0-7 "ly Z 19, 1 L2( Z- Z31 —9 13 b <br /> / o <br /> Contact's Email: 7, ►nnV 1•i 1Aleto �' 9yylu t� (,a VVI / k:r :ate SGV% ��w►�t <br /> **If staff has a question Aout this applica'14on,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWLgov �' N <br /> 3' <br /> Legal Description of Property: PC j (2)0)f LOT- L, `F S IA4S�V�� d <br /> Section#:- Town#:_1. ON Range#: W Town of. <br /> -�l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properq,page. <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: &AcLt G V\ <br /> Anticipated Start Date: (Home/cabin;Commercial Busi ess;Bedroom;Deck;etc) -D <br /> (z,&G IN"', o <br /> Building Contractor: e G ewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SER ICES STAFF COMMENTS/CONDITIONS ONLY 6 z <br /> THIS PERMIT S-S BJECT TO ALL CONDITIONS LISTED BELOW: e ;0 <br /> D kul+ MA l0 S i Se,-E-loct(,k +0 ( rtppe y- F l i ne <br /> LInre,U.�� rtj M 4 4-0 -�Q� tt cL 2 bCCLrL Baer SDI � CC <br /> H G <br /> Fee RecA 2-O0 <br /> ��611U,o rRtt,&tMe4+S o� La�e►&j E>L�ans��l �t�1�Gt �� Y�� a Check#:ril <br /> 55�a1� <br /> O�O-h 1M TL213� <br /> U14 <br /> � 4 (,l,Ul,4be m DWeU.in� CodQ��rx� IRSp,eu-b� � an NR.c�.TSa.�-( permi+5 <br /> Date of staff site visit:Z 30 �Zs initials of si a visit sta /Z2 <br /> ff: `' Q <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE:l0 27 <br /> CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o ^' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> Page 1 of 5 �� <br />