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` LAND USE PERMIT APPLICATION — Burnett County, WI g b <br /> Applicant Complete All Sections Below This Line s" <br /> Permit Types and Fees(Please,check appropriate boxes) �� a a. <br /> I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 L cy <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> !N ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 ° ��!` <br /> �/ Driveways/&Campground Structures r <br /> y / pg $125 WI State Statute 59.692(iv)Structures $350 i <br /> Filling/Grading $150 Boathouse $500 I I 1 1 <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> •i w <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ; i :; <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I o g. <br /> 1 r o <br /> Property'Owner's Name: 5A la D. p3 CI R A Ae 1; F Sl L�tr D �oil W l L Z./Al m S 09 07-1 <br /> g 1' I <br /> Property Owner's Mailing Address: `71/ la Q -(` 5(, Am FA y L_0��, 5 4b°/ 1 <br /> City State Zip • n t <br /> Property Site Address: / 77 S ' b4..F. N'TS Bu,Q6-. to' i o � <br /> Contact's Telephone Number: 31 : a <br /> p ��� -S9C>— `�� <br /> Contact's Email: W'��VI a Olson )suet a. g�jillci:', ce,ni 1 <br /> a v <br /> **If staff has a question about this application,you willioe contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: 'aBurnettCountyWl.gov <br /> n <br /> Legal Description of Property: 3 F C 3 1 -TA i 0 'c (e) 51JJ N.E <br /> Section#: 3 1 Town#: H O N Range#: 12, W Town of: W f S T /Y)I412S1l Lf}n11) . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o ' <br /> Tax ID#(1-5 digit number;found on tax statement): 02$ \'► W CA e <br /> Proposed Use of Structure/Addition:_D j,K H I' <br /> Anticipated Start Date: M AI' A6 l AD 2 4 (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) —f- <br /> Building Contractor: NO J F Sewer Installer: cn 10 o0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY tii iz <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: > ;x <br /> 0 Mft+ al yes ,00 <br /> t <br /> co i <br /> Fee Rec:i 2 <br /> Check#: 3 ref <br /> G <br /> Date of staff site visit: 5 f 3/202q2 Initials of site visit staff r r <br /> ��� <br /> APPROVED BY LAND SERVICES OFFICIAL: � DATE: 5 Zy ZOZ 7 U � :;.:, C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> CD <br /> __ n <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />