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LAND USE PERMIT APPLICATION - Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line o w 41. <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) \,X) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W_p 1CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~^ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r"o p <br /> Filling/Grading $150 Boathouse $500 r)>' , <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 obi <br /> m <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. q t <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> g' i R <br /> 0 <br /> Property Owner's Name: `t r G4r 3 ..0(1.e.e-cl6 115e 2.1 o N <br /> Property Owners Mailing Address: 2.D 2.34 V Q-1CJL tl k u� M& 553 <br /> 30 il <br /> n <br /> 1 + City State Zip _ <br /> Property Site Address: 2'' 1 0 Q v elk 2 o y �` <br /> CD <br /> Contact's Telephone Number: ri(p3— 2-2-i " 56t a <br /> i d <br /> Contact's Email: (ol�,ne.f. m cJ(„ � DO , L.OI1'1 `% �� <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0. °O <br /> `o <br /> cm <br /> Legal Description of Property: 2 CSM V t$ P 'LGcq o <br /> Section#: 2g Town#1'140 N Range#: 14 W Town of: j(` A__ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o ,-.1 <br /> Tax ID#(1-5 digit number; found on tax statement): ' (i:8 , i . C7 <br /> Proposed Use of Structure/Addition: V ok €. r r` - <br /> Anticipated Start Date: ;,t et_ 1 , 2/1 Zt-} (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1� <br /> Building Contractor: `J e z Sewer Installer: y p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z oO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> i) iW 4D I e USd - r / UlMai( A4(D17a749'4. <br /> 0 f/efq[nf- ,iof 710 exc�e e.1 1.0 •Ce�ej. <br /> c <br /> Fee Rec: f ib22 <br /> ° Check#: 555e <br /> z <br /> < <br /> -G <br /> m J l_J <br /> vr- <br /> ADnl <br /> Date of staff site visit: s/cV�0-- Initi s of site vis' taff: / t y Q a IJnU tJ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: . _ _ Z 2- c� c <br /> ib G ! <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 111111 <br /> Page l of 5 JJ <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />