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ro <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a� e,, <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Cc p_ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Q N o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W w,, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 N <br /> d <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> d <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `. <br /> ' ' <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. p <br /> z <br /> 0 <br /> Property Owner's Name: 37)•-np . P:ck o <br /> Property Owner's Mailing Address: 3 2 )`1 Oaircy Or 4// OL he-S-1-et" /V l Al Crgx, . n g- <br /> /�� City State Zip <br /> Property Site Address: ,,2(:) 9 3 r,'0 e /(n6 iII (2A 1i ,i lot-try 5 /f:'30 o N <br /> Contact's Telephone Number: 5-0 7-a 6 I - /vo 3 CD <br /> Contact's Email: J I M' '�' Y1rfii I 'C 0 el') <br /> **If staff has a question about this application, you will be contacted via email. Make sure your email address is N -a Ul <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov °. tl° tv <br /> Legal Description of Property: /Si-hod F/V&k,V0 it 5&'1Di v LOT-6 6LA Y UV-Y 1 b 1) d <br /> Section#: r Town#: 90 N Range#: /7 W Town of: Sc,0+4-- <br /> • <br /> t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement): / ?oQ 0(0 ' d <br /> Proposed Use of Structure/Addition: 6'01^Gi 61 <br /> e. <br /> Anticipated Start Date: Tt^he_ i. ao.)9 J (Home/Cabin;Commercial Business;Bedroo ;Deck;etc.) 0 C o N <br /> d z <br /> Building Contractor: al r (i.i 19 litre__it� Sewer Installer: Q S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d Po <br /> CI 11rAk-- CO I-OC4S cn <br /> cm <br /> cn <br /> NO_, JV 4 <br /> 4Q, -6( hU, VAI \4001-1-0-1Wi S- u\(-ct Q Dniv 'a Fee Rer. <br /> z Check#: (,c' / <br /> r- <br /> 'p i � t ) <br /> 7,,,,, <br /> Date of staff site visit:214 1214 4 212212 q Initials of site visit staff 1 W Z <br /> APPROVED BY LAND SERVICES OFFICIAL Ili � DATE: 2/2 3J 202y m <br /> � cam) c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 0 n 14 <br /> coe <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 .. LL .2) <br /> Burnett County, WI Land Use Application -Rev 12/2023 <br />