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a LAND USE PERMIT APPLICATION —Burnett County, WI "Cl <br /> b <br /> 1.4 <br /> Applicant Complete All Sections Below This Line a c . <br /> 0. <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 _ <br /> /Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N r <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g -L r <br /> C11 <br /> • <br /> Filling/Grading $150 Boathouse $500 iv 116 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <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. 0 .0 <br /> 0 <br /> Property Owner's Name: ,k�' A,ivt t)W� =' ` <br /> Property Owner's Mailing Address:�01 J;��dv u�• B ���(�{3 AN 5-pc� <br /> City ' State F. <br /> tn <br /> Property Site Address: //A ) N6i�-Un le-k F7iarif3( �Ic*if bin 3ieiJ7 I T�Zil`l5 o <br /> Contact's Telephone Number: ,�`J-;. Y� - 1 J� - �.� tt C l-, / ��`�'�S`� , �orry <br /> Contact's Email:SiVt tt((awki.— j'>i,wtlllftA /Kh,laV, y(' 0flI t'S �Wl'3colpi • - <br /> "If staff has a question about this application,you will be contacted viiema(l. Make sure your email address ,� <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov A. <br /> ' <br /> Legal Description of Property: r , Y..4 NE Y,-/ <br /> v <br /> 3• <br /> Section#: Town#: N Range#: RI W Town of: `�,,e �`�/( id .2 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.' in <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement):c2`7 5`-/1 3 C <br /> Proposed Use of Structure/Addition: t x/l,acbl(y/`4)/l�t/f{- A Ti'71,/ &-i ring a <br /> Anticipated Start Date: `u(,v.tn,..(V a0,9�-1 (h ome/Cahin;Commercial Business;Bedroom;Deck;kti) :n <br /> �D <br /> 1- <br /> BuildingContractor: UVkyIiVy p+ fjjWj <br /> -how Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i � �1 <br /> < °Q <br /> n <br /> In <br /> Fee Rec:_sT_ <br /> 9 Check#: <br /> .e <br /> Date of staff site visit: 9 /0 'el* Initi s of site visit s • / <br /> nT <br /> L/ [f Q <br /> APPROVED BY LAND SERVICES OFFICIAL: -DATE: 7 �Z / ' ' a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y CD <br /> r Guy <br /> CD C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT M Q <br /> Fill <br /> Page l of 5 11 1 <br /> Burnett County,WI Land Use Application—Rev 12/2023 <br />