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LAND USE PERMIT APPLICATION—Burnett County, WI a `° <br /> I'dE. <br /> Applicant Complete All Sections Below This Line 0 <br /> Q. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 X` Addition/Alteration to Dwelling/Principal Structure $200 °, C1 <br /> Commercial/Industrial Structure $300 ' Addition/Alteration to Commercial/Industrial Structure $200 �v11 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p-.._ i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 k ,~ <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °„ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �' I,,,t, <br /> Filling/Grading $150 Boathouse $500 <br /> c <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `• <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> (S <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> � I o <br /> Property Owner's Name: y' l a f 1 I 11 V IS a n g' N <br /> Property Owner's Mailing Address: is (p O Fr Q ct e! C d a r7QefS� �)J �� N <br /> / City t�// State Zip <br /> Property Site Address: oZ 9411 4I, - V 0 41.1c �0 4 C G d 4 Yl bur 4 l lv= o <br /> Contact's Telephone Number: O i L — �j(j$— j J'.SS" �J y8`s'D a. <br /> Contact's Email: Ilia s( ( I 0 0 150 n 1.- e( aping( I . C O✓YI <br /> **If staff has a question about this application,you Ai be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov g 00 <br /> 5 <br /> Legal Description of Property: Lot a ) an') ‘(14 P t S(, go <br /> Section#: 31 Town#:_38 N Range#: I g W Town of: Wood tier 5. .� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> c1J ° <br /> Tax ID#(1-5 digit number;found on tax statement): a q3 07 _ <br /> Proposed Use of Structure/Addition: 14144114, Vi y'i 14dc t f- d/(a I Qed(0001 o <br /> Anticipated Start Date: ��" (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: /W 0 R;v e-a j Rio/node✓node I Sewer Installer: °f t a 11 S4 ��✓1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF' ...iMMENTS/CONDITIONS ONLY Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Meek al 5ti'1oac,('s <br /> to <br /> �(nA,t,�n� no1 �o C�CC Ptc� 3 6edmS SflN-2�-02 t. <br /> y <br /> Fee Rec:-a.)0 <br /> 2 Check kit)a° <br /> tri <br /> 0r RI <br /> w <br /> (.f 12,EJ r� ; a n C� <br /> Date of staff site visit: ` ` G !J"I Initials of site visit staff: 6) W = <br /> IAI /ALT1 /2/2o2y <br /> _ <br /> APPROVED BY LAND SERVICES OFFIC 1{ L �� � DATE: cn ^' <br /> y Nj <br /> C� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N Q <br /> qffil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTFDPage 1 of 5 ���� <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />