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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line o A <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> d u1 <br /> Dwelling/Principal Structure -$300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Pv <br /> ., <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °. r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 c <br /> po <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `< <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. " t, <br /> 2.*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> z <br /> o Property Owner's Name: VA<,�, \ tl"\ � U o P _'`, n <br /> Property Owner's Mailing Address: ? clx '1® 7N 1 lP W <br /> c,�.r i 5'41,1 w n t <br /> g City State Zip c4 <br /> Property Site Address: 1 D. CSVat.\<b3fi i &aO S Fort V(' `p.� 5 W I o y <br /> Contact's Telephone Number: '11 S 5 at) 0 B 2-2.. D <br /> Contact's Email: CV`►\\Cr,6 e v.)A es,(pa%\ •CC 11\ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,9 i <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWL.gov °Q <br /> 5' <br /> CM <br /> Legal Description of Property: SQ c, <br /> 3t17 Tny 0 P\yk PC.1 Gas i_ - 7 ta <br /> Section#: .. (P Town#: *3 N Range#: kgW Town of: S it . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Cl) <br /> p W ° x <br /> p i3 Tax ID#(1-5 digit number;found on tax statement): 'U _I 6" A. 5,Proposed Use of Structure/Addition: ROrr\4..: -i Vr <br /> Anticipated Start Date: Vesa,) `aC 0 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Q <br /> Building Contractor: 4N'c'cc\ . C1,\3. Sewer Installer: �5$IOW\lai,dC'r' -x � � <br /> d .— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o r. z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> d _ <br /> 0/1 -f- U Se,-I- s m <br /> rri <br /> CI ` ,,/ Fee Rec. /� <br /> 3 - Si/ 4cJ7o" r 2 de • <br /> °z Check#: 3 c►g <br /> �K-�-AS eX 2i/?s 31fe/2b25 <br /> rtaith5 6 /02 CAL ' f <br /> Date of staff site visit: Initials of site visit staff: "� <br /> so <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: J i 202 / to 03 7 <br /> 5 tj ! <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF G a r'.-1 <br /> e <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0. <br /> CD <br /> Page l of 5 = I ' <br /> Burnett County, WI Land Use Application-Rev 12/2023 J), <br />