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. LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' c A <br /> p a 0 <br /> Permit Types and Fees(Please,check appropriate boxes), a <br /> Dwelling/Principal Structure $300 A Addition/Alteration to Dwelling/Principal Structure $200 10\! <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 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> 0 <br /> Filling/Grading $150 Boathouse $500 IP <br /> to <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> , <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. gn <br /> � qq JJ z <br /> Property Owner's Name: l,It�U u1 �(, o <br /> Property Owner's Mailing Address: 1 D ��Q S(x,�� �� I�/ t �Y ` r) 0 <br /> p Q ( r'Gl�1,lXt ���QIMG� `l�' ,� J,t�ityk '" $30 < — <br /> Property Site Address: + p' o N <br /> co <br /> Contact's Telephone Number: 'I(0� - ).11 U 1 ( O a <br /> , <br /> ,M <br /> Contact's Email: fS j 1 77 r a;� 14 n W�l <br /> **If staff has a question about this appli on,you will be contacted via email. Make sure your email address is N -C <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0 <br /> 2 °O W <br /> iv i jj'' h <br /> l a ai aiU, /� 2-V V lets 0 <br /> Legal Description of Property: <br /> . <br /> 1� <br /> Section#: 1 L Town#: 40 N Range#: rfJ_ W Town of: jatkSeil 6' ^' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> Tax ID#(1-5 digit number; f don tax statement): ©� N <br /> c.4 t7 <br /> Proposed Use of Structure A ditio • -a 9 °JCl <br /> Anticipated Start Date: lb (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f� <br /> 01 �1 I SCC( �Q Sewer Installer: /VII x <br /> Building Contractor: W <br /> w Q <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> 0012e+ at it-H2 ac k s aUN <br /> m <br /> c <br /> cn <br /> 42 <br /> ,1 Fee Rec: ✓ 1 <br /> °z Check#: d'87 <br /> r <br /> ^C <br /> n <br /> n <br /> m <br /> o <br /> l J <br /> Date of staff site visit:5/237Z02/1 Ini ials of site visit staffT 1 611.- aliTi <br /> APPROVED BY LAND SERVICES OFFICIAL. 0/4/ DATE: 5 iglizzo ° <br /> < 3 -< <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2, m inn <br /> Co C <br /> CD C SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0,z <br /> r....1 <br /> C <br /> CD <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />