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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> ,. <br /> Applicant Complete All Sections Below This Line o' `' N <br /> CD I <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) : <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 N.L O <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> ., <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> I Filling/Grading $150 Boathouse $500 <br /> c4 <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. & , <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' z r <br /> o <br /> Property Owner's Name: 1.-Q p e R g-eau k-fl e__ o N <br /> Mailing 7�� l 01 D r Prs c fl2)\) 5 3) 1 (... ::-.., _ <br /> n <br /> PropertyOwner s Address: 7.. • <br /> City State Zip ° ( a ‘ <br /> Property Site Address: 6'3 C 14 sfGt-' N W 1. 7 7 Oaf) b i r I w z 9820 o ti <br /> Contact's Telephone Number: a 1 .Yt ) -9-DC) ap <br /> a. <br /> C7 <br /> Contact's Email: jb 13 cY,ts 7 @ 1 I . c o rn ' <br /> **If staff has a question about this applicatiori,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov o °Q <br /> 0,71 <br /> Legal Description of Property: 5 C L .) a L 1 4.5 /Pei_ coQ Las 9 4,5 .De5c V )336 g. <br /> Section#: t 3Town#: Li I N Range#: /(I W Town of: Su-i e� <br /> 1 SS PO a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cnf <br /> Tax ID#(1-5 digit number;found on tax statement): 11 8 Si ll4 ' <br /> Proposed Use of Structure/Addition: �qc''CN C,-e_ 2-{ , )(2 g ' iv <br /> Anticipated Start Date: - /,,s S✓,-+-r1 t (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) i x —C. U.. <br /> th <br /> Building Contractor: Sewer Installer: vo J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o p, <br /> 01fl e A aU St+baJ-5 <br /> r, <br /> 0 N p-i- -0 bc, v,s,e,ci -f-br i/vAirrtaci koJoi-t-akim . S-f-oralt, onlil „, <br /> -3 Pin <br /> a Fee Rec:/ — <br /> °z Check#:.2,2 — <br /> fI.&c . a 5-8-a2 95 QF. <br /> Date of staff site visit: "1 /3/2024 Initials of site visit staff: 4-&'L rn <br /> o ---"--L J <br /> APPROVED BY LAND SERVICES OFFICIAL��.11A/ DATE: 11/`1/2.02 > n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF L" <br /> o <br /> N ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 13 y c <br /> " "� 2-' N �l <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />