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LAND USE PERMIT APPLICATION — Burnett County, WI e <br /> c. <br /> y it, <br /> Applicant Complete All Sections Below This Line 5 a41. <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <br /> V/Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 14 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i <br /> Filling/Grading $150 Boathouse $500 v) <br /> a <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. K Z <br /> A <br /> Property Owner's Name: 2- /�/�}� l !`J ID <br /> -C <br /> fi,'n G z° g <br /> Property Owner's Mailing Address: LID 33s" (TQ rl er-ri i'rt er t rn� 5�G'3 1 E n W <br /> �✓` f L° COState Zip E IN <br /> /� c� ^-Property Site Address: / i r <br /> `LA F Y i , o v <br /> 7 � a. <br /> Contact's Telephone Number: / 7 d <br /> Contact's Email: 10 Y1 (/1) Q 1 1 4 ) t C 0 t'f /4` <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,b W <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov ° °° <br /> Legal Descri**ptio( of Property: `r 'd^b Q , l�w '/ i c' g d <br /> Section#: `( ,(l 1 1 RangeI �� <br /> Town#: N #: W Town of: �1d l -C <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C' <br /> e w .3 2_. 24L1 Ile z4 c N N <br /> Tax ID#(1-5 digit number; found on tax statement): ,, Z+ e .16 etre oq <br /> Proposed Use of Structure/Addition: Hi irt t il) M <br /> Anticipated Start Date: m A Y(, 1. f 6 ‘ ? 7 (Home/Cabin;Commercial Business;Bedroom;Deck etc)2 <br /> g <br /> Buildin Contractor: IAAi 4 l4 n 1.,b C Sewer Installer: CAM de fq d Jri g v' <br /> o N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rri z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> • <br /> 0 fl1f f at st ack < s <br /> ��a!r ''Sre/ 2 33 <br /> 2 ri0+ 4 e 2 SRN- y- ri <br /> �� )) t S0 l� z !i o Fee Rec: <br /> 0 0,ed CS PVI -11, CA2 WI V/yl,e. Gt j�IXJG 5 lb / Check#: <br /> f <br /> u n <br /> Date of staff site visit: .5(i'i/ZD2L/ Initials of site visit taff: � t <br /> o �`� DATE: 3 I s a2y i t =-�_�-��r, <br /> APPROVED BY LAND SERVICES OFFICIAL. D,(��"`� l / tl u t <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD c a <br /> (D Q U u 1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> i � cm)N C <br /> Page l of 5 4 �` 1fl <br /> Burnett County,WI Land Use Application—Rev 12/2023 = �� J <br />