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LAND USE PERMIT APPLICATION - Burnett County, WI a to <br /> Y b <br /> Applicant Complete All Sections Below This Line 0 co w <br /> Q. <br /> Permit Types and Fees(Please,check appropriate boxes) C7 'P.- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <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 $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 <br /> a <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 tothree times the normal fee. i <br /> ro <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. b <br /> ",., c.:( <br /> z <br /> Property Owner's Name:R a G. d' � L G /I .11 <br /> Property Owner's Mailing Address: 2-,5 ,f2 1a. 11. <br /> (, S t g Lb.:,4s y t � •� F n icw <br /> City / Sji <br /> to Zip <br /> Property Site Address: 2 �J A C2 .5 . Oa.-,A A R C �e t sf It ..5if"9'i •o N <br /> CD <br /> Contact's Telephone Number: 6 5 ( 5 J ` L �-C"n d <br /> ° <br /> Contact's Email: K 0 0 9' r A /3 G'1.4A , ; ( , corm,rm, <br /> **If staff has a question abut this applicatio ,"'You will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o' °Q <br /> 5 <br /> @BurnettCountyWl.gov ( n J_ "Q <br /> Legal Description ofProperty:S LIDO II OS' 0 Si oC Sw �g ` C, ''y a i <br /> 1 <br /> 0. <br /> Section#: 0 Town#: 3 7 N Range#: /(c, W Town of:%YZt?e,exp". cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* w & i <br /> o 5 <br /> Tax ID#(1-5 digit number; found on tax statement): f' 9 A.5- <br /> �dProposed Use of Structure/Addition: 9e /5 h <br /> Anticipated Start Date: ✓ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> n Q ....1) ? <br /> Building Contractor:i i� � ti S C%.r�T Sewer Installer: 1 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> fitie4 lI 5.+bA•c14/5 C KS-f be 3 - ceitici b./it �r- <br /> A 1 c)1 ,, z)r koieui 61):4-rdi'cA <br /> 3 Lcl4 f dii..1 r €&L on seek( h (.c/ !J I WII a3 x Fee Rec: / <br /> o Check#:Cock/ <br /> m <br /> i . <br /> �/ <br /> Date of staff site visit: ? 13/d.3 Ini 'als f Si v' staff: WAPPROVED BY LAND SERVICES OFFICIAL: el-C- -6 DATE: 7/1 V W c 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t o <br /> C 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .c N <br /> w EN <br /> I of - f ' <br /> Burnett County, WI Land Use Application—Rev 3/2023 v 4 <br /> a <br /> 3 <br />