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LAND USE PERMIT APPLICATION —Burnett County, WI k s
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<br /> _ Applicant Complete All Sections Below This Line 0 ro w
<br /> Permit Types and Fees:(Please,check appropriate boxes) j .,r ,,;a) d
<br /> Dwelling/Principal Structure $300 ddition/Alteration to Dwelling/Principal Structure $200 ro 'i
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 VJ
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 OQ a
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
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<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F. i
<br /> Filling/Grading $150 Boathouse $500
<br /> Solar Panels(Stand alone or roof mounted) $150 ✓ Permit Extension(1 Year Extension-Allowed Once) $100 a '
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<br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. •
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<br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. a
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g =' `
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<br /> Property Owner's Name: ,r .,,e,Q 1 • leA e<A K.i sslle_r c 4 j ,
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<br /> Property Owner's Mailing Address: /37 1 El>h resT Au 2 (,t7�1 tC. -,a2 M/� 5S�/Li n
<br /> I/ City State Zip ' i
<br /> Property Site Address: dti73c)1 \!J , Lor\nor- L,ik t Ace tu,�iiS(c_r' (.ii 5`f£i£�[ o a J .
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<br /> Contact's Telephone Number: (did, 80{SSA Or 6,(;L (o!o r-O67j a
<br /> Contact's Email: KS K S S 0 Q 6) G,'nc,, I. , Cc-.,,Y1 n
<br /> **If staff has a question about this application,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 addresses: CBurnettCounty.org and °_ Er,' �-
<br /> @BurnettCountyWI.gov cp
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<br /> Legal Description of Property: Sec .: 5" Ili ` 0 Rc i(o S I i5'Got'Lof3 Lfi L E T w
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<br /> Section#: 3S Town if: t ki N Range#: 1(.:, W Town of: LJeSiSfe-r cn
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* kA o x
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<br /> Tax ID#(1-5 digit number; found on tax statement): ( (tO 2`E O
<br /> Proposed Use of Structure/Addition: L{u i;�j at,,,...�t` s (r'�fe.le A -r o�Qce l.''c�o.•�n S) C
<br /> Anticipated Start Date: (YIALI a°J..), (Home/Cahin;Commercial Business;Bedroom;Deck;etc.)
<br /> Building Contractor: 3oc.e. re.c,1L Sewer Installer: Wrii'c_,
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z
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<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
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<br /> • Fee Rec:
<br /> se Check if: 55 el V
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<br /> Date of staff site visit: / / '�� itials f site vis' staff: i S e,
<br /> APPROVED BY LAND SERVICES OFFICIAL: .1,, r , DATE: I I - W n 0.
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<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o g N
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<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w
<br /> Page 1 of 5 (..... .)J
<br /> Burnett County,WI Land Use Application—Rev 12/2022 i
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