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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> s. , <br /> Applicant Complete All Sections Below This Line <br /> co <br /> Permit Types and Fees(Please,check appropriate boxes) . <br /> :' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cc <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 �\ <br /> Accessory Structure(Commercial/Industrial)• '200 Addition/Alteration to Bunkhouse $150 <br /> 0 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 CD <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 E i <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' <br /> b <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. le f E c <br /> PP <br /> Property Owner's Name: 14o) 61:4 bJ n S L'�' (.-- ° 6f�1 f1`C,�IL�i' 'rl N <br /> y I o <br /> Property Owner's MailingAddress: Lii, �d very' ire ,/ ' / i , °' r- <br /> 6PrtY / 7It __ -�u7 <br /> � �q �q `f►, ii �,�p ity State Zip 4 <br /> Property Site Address: t--f / (� VV i'� u y - . .o y <br /> p ZIq - 37DF- q70 `�Contact's Tele honbrIkt <br /> Number: <br /> ,,( j� � a <br /> Contact's Email: ��� ( (A i i % CD' <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 thefollowing address: @BurnettCountyWl.gov, °Q <br /> Legal Descri ti of Property: (_07 qt4 i 2 V t,1 d I~v(5�6� At t7 / d d <br /> Section#: Town#: ( ( N Range#: /� (a.) W Town of: S to .5 Si <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> IV 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 0 tN g <br /> Proposed Use of Structure dition: 6J14i / l6E (Ai VV el Slit y` y v\ N <br /> Anticipated Start Date: ( 0 (Home/Cabin;Commercialiness;Bedroom;Deck;etc.) T <br /> g .-. v - 1 <br /> Building Contractor: 6 - �r`n5 LLC:Sewer Installer: W 4� y <br /> c„ _ <br /> OQ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i : <br /> D RIRef 0 R-$6u�S r �- <br /> C <br /> n <br /> tri <br /> n1 61 . VI710:01in I y va <br /> I`O VtttA ( i , v �e on 1 Fee Rec:/,Jd <br /> 9 Check#:t54' <br /> Date of staff site visit: 51/ )-Zji <br /> �� E <br /> f l9 Initials of site visit staff: GL T <br /> APPROVED BY LAND SERVICES OFFICIAL lArTfiffirerl/ DATE: 6/ //202q N g <br /> 0 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF L� a, h <br /> C0) o EE <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT [g * co <br /> co <br /> Page 1 of 5 �r J <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />