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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a § <br /> N <br /> Applicant Complete All Sections Below This Line c v w <br /> Permit Types and Fees:(Please,check appropriate boxes) a 00 <br /> o C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ��p <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �'\ i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 O, <br /> v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' \.. k <br /> Filling/Grading $150 Boathouse $500 cn <br /> qh / <br /> a <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. '5 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> Property Owner's Name: C -lam! /Y7tr'i14► !-r / i`1 C GCp M R.tAA attext L(,(a. <br /> �3�1 �,D �i � <br /> Property Owner's Mailing Address: ���� V / i, 2/ �. <br /> City State Zip 3 <br /> Property Site Address: ,A‘...."4 J--1. - y 1 <br /> Contact's Telephone Number: OG'5/- 3'4 .- 0f6(. CD o i.`i <br /> Contact's Email: int/P19/e/ .-POC �� ' �'lJ�R <br /> **If staff has a question about this application,you wi e ontacted via email. Make sure your email address is N .ti ., <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 00 <br /> 5 <br /> @BurnettCountyWl.gov w <br /> 0 <br /> Legal Description of Property: i'L) N F <br /> Section#: 2.0 Town#: Ll 0 N Range#: ( Li W Town of: `jC_;; cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): I r7g C7/ <br /> Proposed Use of Structure/Addition: 'C)/� Z4/2.0 °IZ <br /> Anticipated Start Date: - 1 - 20 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: �.�ff'1�/ /'J �/J� � Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJE T TO ALL CONDITIONS LISTED BELOW: <br /> (VI eel" all 5e-449 4- S - .. <br /> lop 1.17+ ,6( Lv✓c o1 k b,-1-=,h v✓\ <br /> (f / as <br /> ®�I,.6-�- Qek Wass 0! l'?3 z Fee Rec: �� <br /> J <br /> o Check#: Y9 d <br /> r 60 Mu i$ '>1' <br /> - CD <br /> 4/6/2-3 r- <br /> Date of staff site visit: itial of site v' it staff: co <br /> 0.y/6/�3 3 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: m 3 n k•. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ° 0 N T ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .. m.3 N w < <br /> m <br /> Pagelof5 . � <br /> Burnett County,WI Land Use Application—Rev 12/2022 - <br /> a <br />