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CI <br /> ` <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> NI <br /> Applicant Complete All Sections Below This Line 0 c' <br /> Permit Types and Fees(Please,check appropriate boxes); d <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 <br /> \O <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 '� <br /> Filling/Grading $150 Boathouse $500 B <br /> u, <br /> Solar Panels(Stand alone or roof mounted) _$150_ Permit Extension(1 Year Extension-Allowed Once) $100 w �_ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '� <br /> b <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. ' 3' `II <br /> o <br /> Property Owner's Name: rgy1.>fie. .r- :t',.mod•` `I'f'1 Pi Ne�i' N Z <br /> CL <br /> Property Owner's Mailing Address: 4 (/ 9 1 ' 'I 3 d, al�J�S ev /az syg?.� 7 n v, <br /> ` City State Zip ° E <br /> Property Site Address: S� `e Ci 4O1/ <br /> o ti <br /> Contact's Telephone Number: 7/S— �� ` 8Q CD <br /> Contact's Email: b'Y-oz., it J (eil�- O)l & O ' A e c jawY ��h� � � O <br /> **If staff has a question about this application,yo will be contacted via email. Make�ure your email address is N ,0 <br /> legible and your email provider will accept emails from the following address: @BumettCountyWl.gov 0 °Q <br /> Legal Description of Property:145r 2, CSIY1 U Io 19165 (IN GDV LaI g, d UN <br /> Section#: a 3 Town#: *O N Range#: j 7 W Town of: a 71 10 'n s. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> °Tax ID#(1-5 digit number;found on tax statement): 2 ‘l &S. W a o <br /> Proposed Use of Structure/Addition: 61 62.4. !t..,i t i -- N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: y <br /> CD <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o Ix <br /> No+ -1-0 be. used - un if � <br /> rn <br /> 2 =3' <br /> lt4-r- -6✓1 NA k�br , 0 k c-c-I-rn s+riA uh.r,re p laGuw1 f Fee Rec:fr50 tP <br /> ° Check#:74/V <br /> z <br /> a <br /> Date of staff site visit:S/i 4/ZcZ'( Initials of site vi 't staff: - / rn <br /> 0 1— <br /> a <br /> APPROVED BY LAND SERVICES OFFICI a ATE: i u)co 0 <br /> m c :y <br /> UPON APPROVAL: APPLICANT UST POST COPY OF 2 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD 73 K Crd <br /> Q <br /> trit <br /> Page l of 5 CD <br /> Burnett County, WI Land Use Application—Rev 12/2023 L. .)J <br />