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• LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> cn IN) <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> _ <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 6,eck tairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t (� <br /> Filling/Grading $150 Boathouse $500 \` <br /> CA <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. S <br /> o ' <br /> Property Owner's Name: fie 4 -2 f3C_I� rV Ai/ o W S <br /> _ n b N �� <br /> Property Owner's Mailing Address: /..31/0'l- \S pti'qut"( 6i, Nl-) A yjjj2 if,t, sTsoe� , <br /> Q City State Zip vi <br /> Property Site Address: /0 F .& Ski,I/j h I- (: Li- <br /> Contact's Telephone Number: (c, 1 a) q 90 .- ( 9&" a <br /> 0 <br /> Contact's Email: J Cdi c( ilia 6,�i MI Ar 1/ 'Cc M <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,9 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 °O <br /> 5' <br /> cm <br /> Legal Description of Property: S Ky 1'5 hi- Gl-e,; . 3 d <br /> 4hb— <br /> Section#: Town#: y U N Range#: )S W Town of: ria C k 5 61J 0' <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): :_; <br /> d it <br /> 5 <br /> Proposed Use of Structure/Addition: nY�� ,--3,--3y <br /> Anticipated Start Date: �a)r%ja-e. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: y d N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> G <br /> 194pe1y -6( a4dresj by 6/► (Zo2L1 <br /> Fee Rec:, Z 5--� <br /> S ° Check#: 52 <br /> (31411 black a�r,P Trdy ►ve,�' -lv ccvt-1 � in At on -ink <br /> Date of staff site visit: 3I«1 iozq Initi s of site vi 't staflf/`T - G.L. m <br /> �� <br /> /� o <br /> APPROVED BY LAND SERVICES OFFICIAL: hATE: 1 131ZO2q <br /> co co xo, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <._ 0 <br /> 2 , o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o= ,a <br /> 3,...‹. CM C4 <br /> r.� <br /> Page 1 of 5 g (M <br /> Burnett County, WI Land Use Application—Rev 12/2023 jJ <br />