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LAND USE PERMIT APPLICATION — Burnett County, WI a 0 <br /> s. <br /> Applicant Complete All Sections Below This Line o c <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200nikm <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 <br /> ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> � <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 cII <br /> Filling/Grading $150 Boathouse $500 • <br /> ,{ Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 74. <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. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. .» ' <br /> Z % <br /> r- ^ ° <br /> Property Owner's Name: ��,,"��r ,,s0 r o '^t N04 <br /> (� iiiz1 <br /> Property Owner's Mailing Address: � Q �c1 ;S n 'r <br /> — ^ I City State Zip k) W <br /> Property Site Address: 'r %l�l� ���Z 5 J O\nSt,n Lfl.4 o N <br /> Contact's Telephone Number: L. —g r� — I Cpn6 a <br /> 0 d <br /> Contact's Email: C"i et t�ds Eby& cc St. y f).e_ l , `,_ <br /> **If staff has a question about this application,yo wi be contacted via email. Makek sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 °O <br /> 151 <br /> Legal Description of Property: ?C1.C, h 40 <br /> oz <br /> p C11 N <br /> Section#: v�3 Town#: 1—{-?1 N Range#: / W Town of: P>L LJ�tie n <br /> W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> N E <br /> Tax ID#(1-5 digit number;found on tax statement): I l i , N W g 5 <br /> Proposed Use of Structur�e,/jk : C,c.�dditio lee r' ii(—,r'Cb.v -•3 <br /> Anticipated Start Date: c,[lc (Home/Cabin;C6mmercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: H s.:02_.t Sew ter: O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> 0 <br /> 0 PAQA 0,),A S-QMOCUAtS x <br /> rz W �o be CovhO'►net ►--^�'�^ a Ce.r-4-i4 e.8 SL,.rve.l 1M.a1 �G5M by r _ <br /> `J Fee Rec: /6 o"2 <br /> 111112D2y z Check#: lO v 2.. <br /> Tare Shed 40 loe__ reAtO"e-d Dr f.exaki-He-d by Lii i 1 (2024/ <br /> m <br /> mA <br /> Date of staff site visit: 3 18 I2C2q Initials of site visit staff I 4 al.— rn t J <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 3/20/202q 11 u i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <W 0 <br /> 2 � 'Rd <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N " <br /> 0 <br /> 91`G t•a e <br /> Page l of 5 4 till <br /> Burnett County, WI Land Use Application—Rev 12/2023 = �` JJ <br />