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LAND USE PERMIT APPLICATION—Burnett County, WI a 2 b <br /> Applicant Complete All Sections Below This Line 0 CD I <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> 2 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .moo <br /> .) Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ql 1 <br /> Accessory Structure(Commercial/Industrial) $200 ,Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk ,Bunkhouse $250 °, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 gr „. < <br /> Filling/Grading $150 ,Boathouse $500 O w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `m� <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. V <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> z' <br /> 3— <br /> Property Owner's Name: 5'it,..., --,,1 t. LE t 1 LI: o OS <br /> 0 <br /> 0. <br /> Property Owner's Mailing Address: 110Og 01 CREEV-1 I. XI►`, l/vtz1/F , I ( '7(p I O w <br /> X <br /> City State Zip 7 E <br /> Property Site Address: 6 1 q a4,I1 a I L TRAIL) 17A1'I.t3UQ`(, Wr 5-21530 0 <br /> Contact's Telephone Number: go- 318--2-2_ /G 0- <br /> d <br /> Contact's Email: �1--W-='1.--1 ec'1"4 c;0"4100ie.•(C't `' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,.� <br /> o <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWI.gov °Q <br /> ((���� ���� I/ p n, p�� 5 <br /> Legal Description of Property:(JL.AL F Ij� 4 C 1 E 5 LOT 5 t. <br /> .. <br /> Section#: 5 S w Town#: T'-I I N Range#: 0.17 W Town of: `.5 VA 153 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o -3 <br /> Tax ID#(1-5 digit number;found on tax statement): 2.2_,s 6 f W W <br /> v- <br /> Proposed Use of Structure/Addition: R..J ?OKT ,-3 E [,.Anticipated Start Date: 2'1 J:,k- 2'� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N <br /> Building Contractor: (u HE12,(AA:'J B LA t L 0 i\i t)S Sewer Installer: 7, ' LA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> r z <br /> p THIS PERMH2aLk <br /> T IS SUBJECT TO ALL CONDITIONS LISTED BELOW:� + VW" Yl > n l <br /> Z N(31 -b 62, UI41 Tor hmum IN,121l i › Fee Rec: /16°D <br /> f <br /> rT l( Ul�.l(.� � 9 �p{��il \QQ C OlC� G'\i S pOs2� z Check#: �� <br /> prqeea-Li m <br /> 513oIZO 7 Initials of site visit staff:*T 4 v) <br /> Date of staff site visit: r <br /> m <br /> x BTU <br /> APPROVED BY LAND SERVICES OFFICIAL. /i __DATE: 3 Z02 -0Qm co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF cD <br /> 0o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a 4 <br /> Page 1 of 5 3 '' <br /> Burnett County, WI Land Use Application—Rev 04/2024 _ �L JJ <br />