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LAND USE PERMIT APPLICATION-Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 3' <br /> Permit Types and Fees(Please,check appropriate boxes) a;,z, k1 VJ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ( <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> a <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <__ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> 0 • <br /> Filling/Grading $150 Boathouse $500 , <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R.;v - <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `� _ <br /> .10 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r a ,, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o =' <br /> z P <br /> , <br /> Property Owner's Name: P h4(,p �-}�:'c.s ( Dail;el L ivir- � '1,-..)ca o N �1 , <br /> 9 192 t t°► • S' �QW 1i ics-wNu W C $ (k 1 <br /> Property Owner's Mailing Address: a <br /> City State Zipj,„„, 4 <br /> Property Site Address: -Z '7 e)L" S t.. Rs."' 1'-p", �cNta�)R1 1 9�8 X� <br /> 7' o 0 <br /> Contact's Telephone Number: —1 I� --Z-2-� `c:69 Y 1 N d <br /> Contact's Email: ?l1 tl.' , Y . 14 L ��S 5 A�`k_1,cc,��. <br /> **If staff has a question ab t this applica n,you will be con ted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWLgov a °Q <br /> Legal Description of Property: 1,st Z LS m t'lct v Ol L`i f 1 Z-2 -/Dix 4. 15 6(;)�QA,( �� ° (v <br /> !( - 10 <br /> Section#: 51Q, Town#:--1-4 0 N Range#: 'R I W Town of: c._.V,, z),r, ii N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7 , c' <br /> 0 0 o m <br /> Tax ID#(1-5 digit number;found on tax statement): 3Cp('1 e <br /> Proposed Use of Structure/Arddi •on: 5101e 40 `Dr() L p Gc c- ka X-S, ty). 1�, e � H 6(A) <br /> Anticipated Start Date: I t 1..)-4 (Home/Cabin;Commercial usiness;B droom; eck;etc.) <br /> Building Contractor: )A �L Sewer Installer: (Al <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/COND TIONS ONLY o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o PzI <br /> c mt 2f au ,e,-1-10ad-S — <br /> Fi <br /> 0 ft . used Of- \Awirta.41 , -C M , S-1-orct7 c ly <br /> ® N tliJ Oit.K U/kJ f t4a orv't lfl Wall n.ees:1.S a Lculd tueFk.rini 4- Fee Rec: / <br /> ° Check#: /33/3c, <br /> ay 71112czy -< <br /> a <br /> y Prm <br /> \11 .� be. Ct1CMC xles� or pesm;- l by 1(1I2oly < <br /> ('� / d <br /> Date of staff site visit: 52J")Z6A Initials of site visit staff: (92-- AT Li <br /> APPROVED BY LAND SERVICES OFFICIAL. ATE: /(,p ZDZL/ , �UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTPagelof5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />