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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> . b <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes) a (11 <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V 0 . <br /> CR <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v\ iN <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> It <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 F. <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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a "'. <br /> z <br /> p <br /> Property Owner's Name: /1()cI#Pc6Z r bifrtJ 74-5,7 / o -- • <br /> 0 <br /> 0. <br /> Property Owner's Mailing Address: Pb g L)( CC --030--i? / �l)1 5 9 8'3 OF z ,' <br /> City State Zip C <br /> Property Site Address: G (-,? 3 1 J i, 7 LJLA/ L e RD D%7' 6 i f27 o <br /> CD <br /> Contact's Telephone Number: �l Z c� � g- <br /> . � <br /> � � a h, <br /> /� d <br /> Contact's Email: y►,.A p A u,c..S'cm t-) i cc-�it Z.L , C QYvA- <br /> 1 <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: @BurnettCountyWI.gov R. <br /> 04 <br /> cm <br /> Legal Description of Property: SLR /�� � ��yl Cn I 1 )C fLI Cc P / F. <br /> Section#: Q)- Town#: lib N Range#: 1 (c. W Town of: O L A 0) <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): / .Frga x ,ED 1V o <br /> ��L - <br /> Proposed Use of Structure/Ad iti n: ,�ji}�G'F /�O f + icS711�-- STI�1�`t C N <br /> Anticipated Start Date: C//�4( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 04 <br /> i AYfr = 0 o <br /> Building Contractor:S; ti1 f �c'►7JS/RUC f/6GV Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'z 70 <br /> 0 <br /> 011/1“,-1- all Sckblac, S <br /> n <br /> rri <br /> r \lW1 %t) \(1,a <br /> a <br /> Fee Rec: !62:%4C� <br /> °z Check#: bP9.? <br /> i, <br /> rri <br /> rz <br /> Date of staff site visit:6/ /ZO2q Initials of site visit staff: if-T ♦ GI L a <br /> ,,, ��Y7 ro ca.= aril <br /> APPROVED BY LAND SERVICES OFFICIAL: 4,11 / DATE: 513/'l.+iGy <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 8 <br /> Page l of 5 a <br /> Burnett County, WI Land Use Application—Rev 04/2024 �L )J <br />