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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c' E 4. <br /> a <br /> Permit Types and Feeselease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> ,Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 " ` .&.p <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> •,Accessory Structure(Commercial/Industrial) $200, Addition/Alteration to Bunkhouse $150 \ <br /> C) Si <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk <br /> Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 0 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 4 r <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. <br /> z i <br /> 0 <br /> Property Owner's Name: P L C p I MA,J t N =' <br /> " i Rol V/A)hM17 Li st 3'i T <br /> Property Owner's Mailing Address: 3(? �j l g f"� i/vC�r U4 l� <br /> Tr <br /> City State Zip ° 3 <br /> Property Site Address: S4 M C _ <br /> p \ <br /> Contact's Telephone Number:&I Z 17 2—O 6 \ a <br /> t7 <br /> Contact's Email: be)it 1ci ►l 5 e cb t.,o-1 r 't R,t • (.-D <br /> co <br /> **If staff has a question about this application,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 0 tin 5ao <br /> Legal Description of Property: Sc e A 1 TA CO r-.tE Ai i o <br /> Section#: 2 7 Town#: Li 1 N Range#: '( W Town of: 5 w/ S s <br /> S. <br /> *Attach additional page if needed for lengthy description OR attach a copy of thee deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number;found on tax statement): i 2 2—O 70 N o <br /> g 6 <br /> Proposed Use of Structure/Addition: Slja Vv -� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) V <br /> Building Contractor: Sewer Installer: y \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY M z ‘6. `C <br /> THIS PERMIT IS SU ECT TO ALL CONDI IONS IS ED BELOW: o z V1 <br /> 0 Ne/- -/19 e Us -cr Jut o 'i 1Q i fr©rte c <br /> cn <br /> m GG <br /> H <br /> .j <br /> Fee Rec: )So <br /> z ein,,,k#: CAS N <br /> r <br /> .0 <br /> A <br /> Date of staff site visit: Ini ' Is of lee ff: i / (�//�0(ZeZVv v co <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z3 ZO Z 3 m U <br /> gWUPON APPROVAL: APPL CANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD � -, Q <br /> cp <br /> Page l of 5 = U� <br /> (...-. JJ <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />