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LAND USE PERMIT APPLICATION - Burnett County, WI cr ro <br /> ro <br /> Applicant Complete All Sections Below This Line o c <br /> Permit Types and Fees(Please,check appropriate boxes) CD I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v U` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk 12.0 Bunkhouse $250 ° Ei <br /> Driveways/&Campground Structures 4}2.5- WI State Statute 59.692(1v)Structures $350 0 • <br /> Filling/Grading $150 Boathouse $500 <br /> v7 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> (*NOTF•After thy-fact permits(permit acquired after construction has begun)may cost up to three limes the normal fee) $ k <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. a <br /> z <br /> Property Owner's Name:_ _ ( )A�i nQ L ��V'(, S' <br /> 7 /� ,' 1 54103 b <br /> Property Owner's Mailing Address:.2J t"�5 P i K� e n a Rd Li3p_As 5` w I_ n c- <br /> City State Zip ( 1• <br /> Property Site Address: 2 5.al ti t4. i 4, 13.1 R a 12)o$4.er wI 54-g 43 cg. N i. <br /> Contact's Telephone Number: I --]15- 5. O -11 D(p A. ` <br /> v <br /> w <br /> Contact's Email: c <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will Pea_L S i 1,accept emails from the&0 following address: @BurnettCountyWl.gov P 04 <br /> 00 <br /> Legal Description of Property: V 'Li d <br /> t <br /> ^Section#: �pt,�J Town#: 7.3i N Range#: 14 by W Town of: ,/►�+eEQ/'trN/ 3 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* '% v' <br /> t18�1,� <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> � n � <br /> (J' e <br /> Proposed Use of Structure/Addition:1 ek <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) OQ <br /> CAnS) .,� <br /> Building Contractor: Sewer Installer: y ^0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 67 z J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v Ix <br /> (D Mee+ at 2 ath <br /> m CC <br /> am <br /> Fee Rec: 5-0d0 <br /> i Check#: CCL51-1 <br /> r <br /> -C <br /> Date of staff site visit: I,3a/Zo2, Initials of site visit staff: r. - ---� <br /> APPROVED BY LAND SERVICES OFFICIALEei,1�O DATE: Z 1/Zv2� <br /> CA ro <br /> m c D <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF - ' ,.__V <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C <br /> N II <br /> N`< N <br /> Page l of 5 cp <br /> Burnett County,WI Land Use Application—Rev 12/2023 <br />