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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 7 m 0 cn w <br /> 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> d <br /> X <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> . <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O�Q O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e �.1 p <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �' w C <br /> Filling/Grading $150 Boathouse $500 <br /> 'ISolar 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. $ \ <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. i ~• 1: <br /> R <br /> Property Owner's Name:? 'c Ii-t/¢S U iUi s- I o <br /> Property Owner's Mailing Address: 70 90 C b c7 fi O to S �i -'d,5.� D 4 �' 0 <br /> / City State Zip _ 4 Z �- <br /> Property Site Address: 70 rl0 CC'7/7 s �j!%==�X f ed L✓t�S��.y� [,.r'.: S 4' 3 c -5 <br /> Contact's Telephone Number: 7/S — 71/-- 0 6c)0 a <br /> Contact's Email: t/1 .14 6 c !it,,,. ei c /t c' .. cc `,- CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and E <br /> @BurnettCountyWl.gov aso <br /> o <br /> Legal Description of Property: 6/8._3 3 0,)1 O,j a OD g. <br /> Section#: ®;. Town#: 3 I N Range#: / W Town of: 1i 1 k7C/0h <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N d <br /> N d <br /> Tax ID#(1-5 digit number; found on tax statement): //D,S.- 1 <br /> H <br /> Proposed Use of Structure/Addition: hit Ail O <br /> Anticipated Start Date: CK tit' II '&C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W <br /> "p —C <br /> Building Contractor: el kv 4 tCC Sewer Installer: .S-gGt--s c?t. /2i L 6±Lt.r <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - kkt-4- a'.k S&b&c kS <br /> r- <br /> -bu.i-cs,.:kapj y\o4 4-o -e,)C d. 2 becieaams per SIB-2 )- J L11 <br /> s Fee Rec:3n0°-' <br /> a Check#: c. g <br /> 2 o .��J' <br /> Date of staff site visit: (0 i 6I Z 7 I i 'alsof site v' it staff: <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 /Zp23 y I <br /> AOo <br /> 0° C 9 Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z o 0 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> c <br /> B Ind <br /> Pagelof5 rn _Di <br /> + t <br /> Burnett County, WI Land Use Application-Rev 3/2023 v <br /> . <br /> a <br />