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• LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> a <br /> a. i <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees�Please,check appropriate boxes) all. <br /> O cj <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 10 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> X <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 .. <br /> Filling/Grading $150 Boathouse $500 rn <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 /> vv <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. a <br /> z <br /> Property Owner's Name: -" e .-� o — M <br /> Property Owner's Mailing Address:0, •'7 5-B CLZ tK if-1? -'1? ' ,tC,lt1(�(,k L(J.l 3 <br /> tV <br /> City State 4ip6 e E <br /> Property Site Address: 0 ) <br /> Contact's Telephone Number:7 I S^ -ac.).3 -. , ....p n. <br /> t7 <br /> r <br /> Contact's Email: V,tea s l 1/N.. a, VOt;'Y.W 3i-(149 te k COVil t YI1-S-- co <br /> **If staff has a que ion about this application9you will be contactbd via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov a' ,, W <br /> aq <br /> Legal Description of Property:1.01 ll CSM V9 P3 iy 4 tzT l o CSM Nici P3 i ci Cx q RN M I d <br /> Section#: U Town#: 3g N Range#: I Q W Town of:INbDCI h IVtA' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> 2� qo $ H <br /> ; <br /> Tax ID#(1-5 digit number; found on tax statement): �, � <br /> Proposed Use of Structur Addition:f k)Ge.YYt,1771-kry <br /> -3 <br /> Anticipated Start Date: • LX (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N <br /> z C1•1 4) <br /> Building Contractor: V'\c its Sewer Installer: yEA <br /> .e <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c <br /> 0 keit- au 5.6-19N,k-s m -..... <br /> < Qv <br /> hold ryii_h oo , cj'4inn G Lu19-2�l-Zl Z <br /> Ciuf N <br /> 4-1 Fee Rec:$I"Z6 <br /> 03 rarrdS -b be 1-e / cDrnbiN.d .1-t/1 a Cer-I►fieJ _ufVe,i Mae (am z Check#: 2-512- <br /> by IDHzovi <br /> m <br /> m r- l <br /> 0 CM <br /> Date of staff site visit: l 1 ize Initials of site vi 't staff:[- + GI L a 0 W <br /> 4 E -0 <br /> APPROVED BY LAND SERVICES OFFICIAL: ✓ DATE: /2 / z m ^ MI <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 o oU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - INE <br /> Page l of 5 LL JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />