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LAND USE PERMIT APPLICATION —Burnett County, WI a r- <br /> g g c <br /> Applicant Complete All Sections Below This Line c 4. <br /> Permit Types and Fees(Please,check appropriate boxes) � G°' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 fV 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 'fi <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 c <br /> I. <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. b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. i `. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. E <br /> 2 A <br /> /Property Owner's Name: R 0 rt94'N re sAfj y,t 1/0e J f H6"/;(j-1 '"• <br /> N <br /> g. N <br /> En <br /> Property Owner's Mailing Address: 1) 7 C 1 S//E t,/Uof S T Ale t bfONIC /•4 N J '? d <br /> City State Zip <br /> Property Site Address: .22/22 e_e)%�- 'AA' <br /> xo o y <br /> Contact's Telephone Number: 263 252 y6I <br /> n fr Contact's Email: RS11e<Sc igAclIA" ;p• <1 l"i �' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,� <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov = °c <br /> p 5'_ <br /> Legal Description of Property: F' /✓ /) .- q <br /> E.Section#: 4/ Town#: 3 7 N Range#: / 7 W Town of: [J ZV CO 4/I✓ (q' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* cn <br /> Tax ID#(1-5 digit number; found on tax statement): /o a rd <br /> W Ci f x <br /> C <br /> Proposed Use of Structure/Addition: 5Tog 04,zr i ' d <br /> Anticipated Start Date: MAt' le A'/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) lV <br /> _ x W �4 <br /> Building Contractor: 5Z'1 I" Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> 0 <br /> is <br /> ORO- cai st-Hoctri-_s < -...., <br /> r 1 1,, I- Can oCD <br /> O Nod -�r I'11�I,W101-►�1 1 IGLYII ' C+ 9" Fee Rec:1 O <br /> z° Check#: t 1 q. <br /> g <br /> tri <br /> 2 MI <br /> IDate of staff site visit:✓ I ZD2q Initials of site visit staff d-r ( < <br /> 0 r- <br /> � . �__� <br /> VI 0) <br /> APPROVED BY LAND SERVICES OFFICIA . / V2/202 L ATE: q a <br /> )03 <br /> ' c W . V V <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q g l <br /> � s18 <br /> Page l of 5 g N <br /> Burnett County,WI Land Use Application—Rev 12/2023 �� -2- <br />