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, ' LAND USE PERMIT APPLICATION — Burnett County, WI c r <br /> s <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees(Please,check appropriate boxes) a k)%1 <br /> v rs <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 is R1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <_ )1/4,, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> up (li <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. $ <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 /> 0 <br /> Property Owner's Name: S><c�� ✓v ti�C o --.C. •� <br /> 0 <br /> 0. <br /> Property Owner's Mailing Address: f #/.9".3 to ", —� 5— G-r/� f4 ---ti-t'" <br /> City State Zip E <br /> Property Site Address: .9;2, 7 ' %,/"., C,7'` //_e...--°'t--p :- c o N <br /> lis• CD <br /> Contact's Telephone Number: 1C% 7- 6"0 - ,?<.,' d <br /> Contact's Email: -y ' -'� : ' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: CBurnettCountyWl.gov . (To <br /> 5" <br /> Legal Description of Property: y/5 `?` r/t.0'✓ C.,, 'Yy " ,01, d <br /> Section#: 2.2 Town#: 140 N Range#: 16 W Town of: ,T.d. , - <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): O 5 61 N g <br /> Proposed Use of Structure/Addition: H tr ° <br /> Anticipated Start Date: // . `/- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: O �+ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> (D my,+ cu,i Se4 ,ac,k-S < cn <br /> n <br /> m <br /> - �� rill , S-f��u �l ( <br /> Nod Ile.R u�L� —l?( ��Yl'l( '� i > <br /> a Fee Rec: <br /> / <br /> ° Check#: `Q7R3 <br /> r <br /> r <br /> m <br /> rr <br /> K <br /> w <br /> r.I <br /> Date of staff site visit: 5)Z' )202y In 'a1s of site visit staff:"��//T + ItC.- W 3 <br /> / Q me (� <br /> APPROVED BY LAND SERVICES OFFICIAL: ,tliG�,/ DATE: 5l2 l/�Z/ <.3 "< v v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF co <br /> 0 0 �) u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />