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v) b r <br /> ' LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line o c 4. <br /> Permit Types and Fees(Please,check appropriate boxes), G <br /> w <br /> 'j<Du�zllin cifl Stx ctur Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure I I_ ` Addition/Alteration to Commercial/Industrial Structure $200 � <br /> Accessory Structure(Garage,Shed, $150 % Addition/Alteration to Accessory Structure1111.— $150 CD <br /> Accessory Structure(Commercial/Industria 00 Addition/Alteration to Bunkhouse $150 <br /> n 1� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 �,� <br /> Filling/Grading $150 `Boathouse $500 <br /> molar Panels-(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? 11 <br /> *NOTE:After-the-fact permits(permit acquired after con ion has begun)may cost up to t ree times t e normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see correspon mg app tom,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 <br /> Property Owner's Name: 7 e r o <br /> 0. <br /> -1/ <br /> Property Owner's Mailing Address: F-rf,/ -6 .� , . n <br /> ,, J City ( Statet Zip En <br /> Property Site Address: ( 7 • , I� ads '+-✓ e1 o N <br /> Contact's Telephone Number: 70)- %j-( --oei j iik.G o <br /> Contact's Email: LC'.Cktr-at •e v``II (� (r1t'1tCa L cm CD <br /> **If staff has a question about t applt ationlou will be contacted via email. Make sure your email address is �' <br /> legible and your email provider will accept emails from the following / / <br /> address:_ @BurnettCountyWI.gov 01Q <br /> Legal Description of Property: $ 9(7 ' OP W q YJ / 5 r + 5 L iii <br /> P <br /> Section#: -VI Town#: L� N Range#: I C W Town of: CJ G <br /> { 1 AS l Ia 6� 0' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* _Z. <br /> Tax ID#(1-5 digit number;found on tax statement): 0 (45 W 0 <br /> C <br /> Proposed Use of Structure/Addition: :34ot-1 9 C.. -� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ` 1 N <br /> Vv �4 <br /> Building Contractor: Sewer Installer: E <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° <br /> z <br /> THIS PERMIT ISSUBJECT TO ALL CONDI/TIONS LISTED BELOW: v Ix <br /> /19m1` used E r W rah A a4l'A 77ort. x <br /> F <br /> m <br /> H <br /> a Fee Rec:07-2562 <br /> °z Check#: 20.2c' <br /> r <br /> a <br /> Date of staff site visit: 7 /° Z9 Initials of ite vis' aff: Ei.i) <br /> VEI <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /2/20ZV 3 oo <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF = r•' rffl <br /> ED p N <br /> O <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> co IND <br /> Page 1 of 5 <br /> �` �J <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />