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LAND USE PERMIT APPLICATION— Burnett County, WI 5- P b <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees'Please,check appropriate boxes) a• <br /> O` <br /> m <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 =i...\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 'tt_ <br /> tn <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 /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Z <br /> 0 <br /> Property Owner's Name: 71/0 Si ,<AyCE e ,a.`s g� ot<S('A ( / o (/J <br /> Property Owner's Mailing Address: 191 4" GA( ?I64) L)i) ✓ C OZ' <br /> 2 5. <br /> Cit State Zip r S <br /> Property Site Address: 1 J /�r,.(-JI�GST POINT � O I�p oo c,e3 S 1 o <br /> Contact's Telephone Number: uJl"aO '' ( J IS NI <br /> f'broO Kshctw 84f o �4/ G _ ° 7- <br /> . r-i . <br /> Contact's Email: / r% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -C " <br /> legible and your email provider will accept emails from the following' address: (icBumettCountyWI.gov �, -- <br /> Legal Description of Property: ►-bT S Cs/h VZ� V 2i ( 3g/ 7) f. eO O <br /> Section#: �5 Town#: ye7 N Range#: ig W Town of': SC0 N <br /> sN <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Cl) 1 <br /> Tax ID#(1-5 digit number;found on tax statement): _.,1, /4� N i <br /> Proposed Use of Structure/Addition: 1417400iu1 '4fi``�( a i c1J <br /> Anticipated Start Date: /¢/54P / <br /> 4Ly n (f-tome/Cabin; ,onunercial Business;Redroom;Deck;etc.) ) N <br /> Building Contractor: wNsr -C/Or' Sewer Installer: 4ki�/. Soi,/, 7 ! p -1- 6- <br /> ti <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (p mz "C' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'z <br /> M <br /> r EC I <br /> g U'(/`)k AC1 vro-{- -A-0 -e x.c te.ci 2 becL a0rrt3 l-E-a-rL( # 36-ioc1 �r � <br /> Fee Rec. I <br /> Diar-mckr k —0 die 110-e-d - 1) MU-k 5 c+ S, - tco C . r e t9-214 —0�-P Check#: ` `a / <br /> 1 <br /> Date of staff site visit: S IP /' <br /> /202y Initials of site visit staff:KT 4' G,L . L J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 'f I i-i/z szq fr,nl <br /> m 1!1111 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <5 = 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o a w <br /> Page 1 of 5 `` <br /> Burnett County,WI Land Use Application—Rev 12/2023 a <br /> JJ <br />