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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> s b <br /> N lJ <br /> Applicant Complete All Sections Below This Line 5' CD .- <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Q <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> N. . Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ 4- <br /> Dnveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 /0 2 <br /> Filling/Grading $150 Boathouse $500 N <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P- <br /> 5 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> -0 <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. g <br /> z <br /> a <br /> • <br /> Property Owner's Name: ���.JQie`. to 1/1 >7 L -Vy0 Zak to, <br /> g N r <br /> pMailing (45'3s � Q- s 40 S�'fey, wl 5 / 2 <br /> Property Owner's Address: 0.V1 .. <br /> City State Zip c9N <br /> Property Site Address: 5c...yt,.e, o ,7. r \ <br /> Contact's Telephone Number: a 69— 7 `1 y- 0 i 3 .i i 1 C rno e, a <br /> 0 f' <br /> Contact's Email:ILO, I e J ire ai Q y'ctiyl-iS ID uI r`j`leJ'Co yr,. t7 Q ` <br /> **If staff has a questiozi about this applicatT4n,you will be dntacted via email. Make sure your email address is N ro OQ <br /> legible and your email provider will accept`acce email the following address:@BurnettCountyWI.gov '• -� <br /> Legal Description of Property: d <br /> Section#: 2.1 Town#: 3g N Range#: W Town of: Dahl t,i...S vN <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C) <br /> Tax ID#(1-5 digit number;found on tax statement): QY oZ 9 N a <br /> N �- <br /> /� <br /> Proposed Use of Structure/Addition: Re,s t = H d N <br /> Anticipated Start Date: y/iZ J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) P N <br /> Building Contractor: � r a. t''1cn <br /> L.v-v d Q a._ Sewer Installer: / ). <br /> AREA BELOW THIS LIN FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> Di <br /> D tyl,k-k- a ut se,-l-k a ,kS < <br /> frl <br /> CA <br /> DA <br /> 1 Fee Rec:l2'? <br /> Check#: 4 3j 3 <br /> r <br /> m <br /> n <br /> Date of staff site visit: /L /Z02'2) Ini 'Ws of site isit sta 4 C LL �7 m <br /> iv <br /> DATE:J f I J/�1�� CA <br /> 4 r �--J� <br /> APPROVED BY LAND SERVICES OFFICIA r~--- Inn <br /> bsv <br /> __ Inn <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a. - u��L <br /> 0� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a a <br /> 00 o <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2023 2 <br />