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e / ' 1 r F r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI cr a ro <br /> Applicant Complete All Sections Below This Line o z. <br /> 6 .p <br /> Permit Types and Fees:(Please,check appropriate boxes) ' C7a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 t�� C <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t b <br /> Filling/Grading $150 Boathouse $500 , <br /> cn i <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> "NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. -0% <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. a = , <br /> z <br /> Property Owner's Name: V a I- y i - ,-e - o <br /> �/ i M7 ` b o0 <br /> Property Owner's Mailing Address: 72 � T %� �u e' al ° tv City Stat Zip _ 4 <br /> Property Site Address: l0 67 e ) < <br /> •0 6 <br /> Contact's Telephone Number: 4/86 -- / <br /> Contact's Email: d-rs)v10 btu r- e l i . c A to v,K , 120,7 7 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov o 00 <br /> 5' <br /> tiq <br /> Legal Description of Property° te r,reS ---i d <br /> Section#:5/(p Town#: 17/0 N Range#: /sa W Town of: 0 t; y1C <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> o H <br /> Tax ID#(1-5 digit number; found on tax statement): p- m f o� <br /> d <br /> Proposed Use of Structure/Addition: SCi eexer7 j•or-c.4 .' e .�. <br /> ' s�l-c Cf>:t , H Anticipated Start Date: % — G1„, i j (Homabin;Commercial Business;Bedroom;Deck;4c.) c9 <br /> Building Contractor: 5F' WI Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rn <br /> o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z x <br /> v <br /> \i bej Size 4b sae reclA4 ,d 10 ' X 2/1 ') fee revised d-al nc) <br /> Fi <br /> w <br /> y <br /> a <br /> Fee Rec:02.co <br /> °z Check#: <br /> v % �J1J u <br /> //� CI) <br /> of staff site visit: 5)i5)Zy 4 5130 2D21 Initials of site visit staff: (7L4-IIVh lT m 03 <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: t9 <'Q 212y m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD _ - CI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I <br /> v <br /> Page 1of5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />