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A LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) � C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ...E"--O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 NC) <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) IP <br /> 4 Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> ADriveways/&Campground Structuresx 2 $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> 1 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 p4 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' z Lit'/ S '� 1 p <br /> �� <br /> Property Owner's Name:_ �Q t Lr 1<-t� rk��E)U p��j,, [el o <br /> Property Owner's Mailing Address: L t !_t r(5 �_ tilk)- 0 C'I W 1 5 gq5 h <br /> �p� City State Zip . 0 <br /> Property Site Address: 21511 �k,1 S b� C�C.►s1� 1 i�+ 5 sq z5 o FA <br /> to a 1 <br /> Contact's Telephone Number: 1i.Q7j z2q _ 'j4� °d' ' <br /> Contact's Email: I AR, ' £0.-i.:.h.LC& t e &(r\ L'k, `(rr F <br /> **If staff has a question about this application,y 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: @BurnettCounty.org and 0 w <br /> S' <br /> @BurnettCountyWI.gov d <br /> Legal Description of Property/4 if WM V I Pi 8) C P(t 60 to-±"LI/1 S• <br /> g <br /> Section#: Li W Town of:5 '' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c <br /> ta <br /> Tax ID#(1-5 digit number; found on tax statement): I v3 7 <br /> y <br /> Proposed Use of Structure/Addition; ��,1 Q.e U Yl SCt {( Li)jCpir(� C� �� 07 <br /> W <br /> Anticipated Start Date:ill 1> lei 2.- /Home/Cabi • ommercial Business;Bedroom;Deck;etc.) O <br /> V <br /> Building Contractor: £, , Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUrB�3EC TO ALL CONDITIONS LISTED BELOW: + <br /> P(;)-e* <br /> 411 <br /> g t) 1 1,,,,, h ct,3vh1 <br /> 721,v4e (�� _ z Fee Rec:3 �� _`� ne Vo G 1' re-mi-L-3 5Kr`T�-e� Check#:�„ a�7C,� S b � 3 !� o <br /> m <br /> z <br /> r r Date of staff site visit:Li /J q I ? 3 Intial of si v' t staff: Ji'17 J <br /> Ind <br /> APPROVED BY LAND SERVICES OFFICIAL: ` ' DATE: 6/y 3 , a n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g a , <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Page l of5 7 � w iiiiii <br /> Burnett County, WI Land Use Application—Rev 12/2022 _ t <br /> a. �� J <br />