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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' c 44. <br /> Permit Types and Fees�Please,check appropriate boxes) O° L l <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �o,,` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n d <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 R <br /> Filling/Grading $150 Boathouse $500 IV <br /> rn <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. i <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. °r <br /> z <br /> /� / o <br /> Property Owner's Name: ��/1�/✓ y'�¢ F� /YI�TY��� c <br /> Property Owner's Mailing Address: c&O3d /y`e-4 6O - �//6— XT/PA( -��77 7.7 w it <br /> Property Site Address: 63 8- + a/✓V Re eFi f City State Zip ° cc) 7;9 , <br /> cp <br /> Contact's Telephone Number: ara -F/ ,- -O/2 °' <br /> n o <br /> Contact's Email: � 6711,7V5q to/e-�� <br /> ro <br /> **If staff has a question about this ap lication, ou will be contacted via email. Make sure your email address is N --C <br /> legible and your email provider will accept emaillsr C G <br /> sfrom the following address: @BurnettCountyWl.gov 00 <br /> Legal Description of Property: /0'% i32 4407 L.4A/E * 0 <br /> Section#: 07ro .9 Town#: A/ / <br /> N Range#: / 6 W Town of: /n et✓10d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C4 <br /> Tax ID#(1-5 digit number;found on tax statement): .�,/ o � d <br /> Proposed Use of Structure/Addi 'on: �1/7tC6- Gtt / . ,0��- :1:, <br /> N <br /> ,} l�t Home/Cabin;Commercial Business;Bedroom;Deck; <br /> Anticipated Start Date: Pitt Y C7� ( etc.) <br /> x N Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> IV <br /> 0 mttif OuU S,--bo kS. 0 AV l s r,esconsibQ -For rn +► nc3 104 <br /> rz <br /> �1n I S�ru Q �� �l, 9 Fee R e c: <br /> V ` 1 <br /> NO- 1ae used -%oru v� Inu,bi-�i-I4 42 <br /> C y <br /> ° Check#: - /5 <br /> cri <br /> z <br /> Date of staff site visit:212$(Lol 2 Initials of site visit staff d _ <br /> ,�I'I � M� 2 r -) �J <br /> APPROVED BY LAND SERVICES OFFICIAL l U( lj�/_ DATE: . /lQ/ZDZL/ r --r 1 <br /> L33 rli 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD c <br /> C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I M <br /> O. <br /> o w Uo <br /> CD C & <br /> Page 1 of 5 v Z <br /> Burnett County,WI Land Use Application—Rev 12/2023 cp <br />