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. LAND USE PERMIT APPLICATION — Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line 5' c 4. <br /> PP P o CD <br /> CL <br /> Permit Types and Fees(Please,check appropriate boxes); <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 _ Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 IJ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 / <br /> G� >Y <br /> v Deck oar Patio/Retaining Wall/Sidewalk Bunkhouse $250 Q , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> i <br /> Filling/Grading $150 Boathouse $500 0 <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 to three times the normal fee. $ <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> z <br /> o :I":Property Owner's Name: / �` ' ���� 7 "Doo � <br /> Property Owner's Mailing Address: 4.5 ?S/91/ (/ � Wela5ter WI- zj / 1. n C.,y I <br /> 'M City State Zip ° CJ <br /> Property Site Address: f , `�.—. o <br /> Contact's Telephone Number: a/ 0 -IVa a <br /> Contact's Email: , Li,OTf O 0 1 / ► 1 a , /' c_J-1 r'\ 0**If staff has a question about this application,)Su va be contacted via email. Make sure your email address is --L <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 °Q <br /> Legal Description of Property: <br /> Ai 7741 Of \A I i��v s�� f d <br /> � <br /> Section#: A D Town#: 3 / N Range#: / y W Town of: {N\f,t,tr10N r' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ,, up <br /> Tax ID#(1-5 digit number; found on tax statement): l/ /,3 7 w N I� <br /> d d <br /> t V fo U �-V NI ver a_cet5 Proposed Use of Structure/ ddi •on .3 <br /> Anticipated Start Date: .i p (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ? <br /> Building Contractor: Sewer Installer: v, Cl —..1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> 0 -4-0,..kfS 0.0+ —10 -t)(c_e_e_4 5c---i- i—i ciu-i-h „, <br /> 19 Land,inf dzck Cando-i- ix 1'Y(o(2 --g/Iar1 1l D SC Fee Rec:/0`15 — <br /> °z Check#: 7,907 <br /> x <br /> Date of staff site visit:2/ O/2-02--Li Initials of site visit staff t o r „J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 2`23/ZpZ1/ <br /> to <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C <br /> 00 = o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD c. ., <br /> CD <br /> u y u <br /> Page 1of5 = <br /> ' , f � <br /> Burnett County, WI Land Use Application—Rev 12/2023 J <br />