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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees4'Please,check appropriate boxes) a a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 j <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 <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. j r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: Pct"1"1^1 Cl c� i Cd-c-Z Ck,-- -" j , <br /> Property Owner's Mailing Address:3275 L D On L cakes R� .Dr-�t� t ud.�ic 'g-�© J In Z <br /> cn le. <br /> City State Zip 3 <br /> Property Site Address:3775 L001 Lo L 1 Darlbo.r�, t S 9i scs C� <br /> Contact's Telephone Number: n <br /> c :14Y•rh e'..dc l 9 ,- ,4 <br /> '/ c c� -'-7 <br /> Contact's Email: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is 1N d <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov - 00 <br /> Legal Description o f Property: 1. FR L 'V 11 /L.v4 A D— 003) o <br /> P P Y �jl ` / <br /> Section#: 01 Town#: y ® N Range#: W Town of: Mc S Or, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* ';` ✓I <br /> to -3 -� <br /> Tax ID#(1-5 digit number:found on tax statement): y g'y d 1^- <br /> I <br /> �c�-Pages (r v+ co h c n Jicab I o�� `� I-.c <br /> Proposed Use of Structure/Addition: --� � <br /> Anticipated Start Date: 5 )3 ` ca 9 More Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> 1,._ <br /> i�- = I fiD <br /> Building Contractor: Se-IT Sewer Installer: )J/0 � id n 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY T Ufi z <br /> o I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> , <br /> Oliqt4 at �,-fb tcs Jul <br /> Fri <br /> II-- <br /> O NN- - \. - r h� katai-kuttffl � Serra on�Y M y <br /> T Fee Rec: <br /> -n <br /> z Check#: // <br /> r• <br /> -C <br /> z <br /> 71, <br /> Date of staff site visit: lIaI2(/ 4 5111211 Initials of site visit staffT*'VIL.. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /z/zbzq <br /> i til) 7.''--12- 015 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' . 1fU(J <br /> m <br /> g o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C, <br /> c <br /> Iffil <br /> co <br /> Page 1 of 5 <br /> `L J <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />