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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> b <br /> N N N <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees(Please,check appropriate boxes) l7 <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :° <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 :l <br /> Accessory Structure(Commercial/Industrial $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Walt/Sidewalk Bunkhouse <br /> $250 � t <br /> XDriveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 a <br /> Filling/Grading $150 Boathouse $500 cn <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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. n <br /> • <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> 0 <br /> 1.1 t <br /> Property Owner's Name: 6-e 2.4 L.p 1-• Ili it eL o <br /> Property Owner's Mailing Address: /g..j/ Nl edki �.4k2 ci xeLE �Vifi,, M P' --7 770. <br /> n <br /> City / State Zip E <br /> Property Site Address: (p I t S'/v 7 1ZD WES i F.�� 7 1.I I S o <br /> co <br /> Contact's Telephone Number: 115- 9 7 0.5V5 .121 a <br /> d <br /> w <br /> CD <br /> Contact's Email: PDy✓l LLE rD A0i.., ee wt IDr 12 C e -� <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 . °Q b <br /> oa <br /> Legal Description of Property,jp;u),ti LAt re-si-pILt )i✓or'DEVILS LAkE LOT 1 e z e "A <br /> Section#:5 21 Town#: 410 N Range#: /(0 W Town of: 4,I1'Ls1AJ l) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn y <br /> Tax ID#(1-5 digit number;found on tax statement): !ti"Z-0 Y 3 d <br /> Proposed Use of Structure/Addition: '-gEpiAAIA/e., ST i RL14S ,9 P1I-4 414/Iyi5 f,w/6 ii.44A/ '-3 <br /> Anticipated Start Date: (, .- i -z Y 1:Commercial Business;Bedroom;Deck;etc.) <br /> 1 <br /> Building Contractor:g t,Dr✓/i.taE' (a;+•'$1 ve l%i7,c/ Sewer Installer: /4 c7, 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d Po <br /> 0 (Y1Qf-I' W. -' 'th w <br /> it <br /> CI 15 combined AA a Cvr4thed Sure/ ryiaP (csnI5 a Fee Rec: 42561' <br /> °z Check#: 70.3f—, <br /> 0. <br /> CO <br /> Date of staff site visit: 9115/Z1-1 Initials of site visit staff: (r 04-14/T- im co <br /> APPROVED BY LAND SERVICES OFFIC DATE: 5 21 A2y cD infil <br /> c <br /> o css o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 3.a 2 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> LM1 <br /> L� J <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />