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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> Applicant Complete All Sections Below This Line 5" en <br /> en IN) <br /> Permit Types and Fees'Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 5,0\lc.1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/industrial Structure $200 <br /> X( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 r <br /> s <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 A' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c ink <br /> Filling/Grading $150 Boathouse $500 Q <br /> gl <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. V v <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o •, <br /> z <br /> Property Owner's Name: - (4' 3 C--E2- <br /> o <br /> Property Owner's Mailing Address: V Li `N1 .A-OS £C-e./n'' e b U1"-ib C E, it.- &))ig i <br /> /� City State Zip k' <br /> Property Site Address: Zr�1 c' . Act. �1\iNi.3t.f2`( Lev i S 330 o y <br /> Contact's Telephone Number: ( (z)30� (o(,,(e 3 <br /> a. <br /> d <br /> Contact's Email: -CA C t--G-C-G2- 9 (., ( t L < C .^ <br /> **if staff has a question about this application,you will be contacted via email. Make sure your email address is N ,z1 <br /> legible and your email provider will accept emails from the followingii address:@BurnettCountyWI.gov <br /> i <br /> Legal Description of Property: Cri VT" LcT' (42 be-St 33 ioo 41. t? <br /> Section#: U, Town#: d N Range#: /tf W Town of: ct eTT <br /> 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> ,b o m <br /> Tax ID#(1-5 digit number;found on tax statement): . ' / 4 0-/ 11 = <br /> Proposed Use ofStractu,a/Additiion j (�/V2PcG-E 1" -i <br /> Anticipated Start Date: K //Ze 7-'f (Home/Cabin;Commercial Business;Bedroom;Deck;etc) • , ^ -- <br /> Building Contractor: Sewer Installer: ` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a z •-' .. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i <br /> al <br /> e-0I.It' ITtc).1S trJe".1T F/ED i Al VA 4,vCC ZS1--01- S <br /> 0 <br /> 061/0/A3 q// 60u(4i�o1s .' r Uf-R -Z'/--o7. °� <br /> 1� / _ / / / ,� / t Fee Rec: f�r <br /> ell /V 0 f 7v b e U s E-d -r A u M-t q h A a 4 I Q 77 ,/4 Check#: Ce S k- <br /> I <br /> ' c2 l J <br /> vl <br /> Date of staff site visit: 3//9/O01 of • visit staff: / " ari Ind <br /> a Uull <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: .0J/ 2 g° > n <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 2 2 o ffil <br /> 00 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w Q <br /> Page 1 of 5 CD <br /> Burnett County.WI Land Use Annlieation—Rev 04/2024 �` .)J <br />