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Er04.( /k PP &J Puernv- , ?c,d_drzess�s- r <br /> LAND USIPERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o <br /> CD i <br /> Permit Types and Fees(Please,check appropriate boxes) ° 'hl <br /> t709 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 • r> <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 t� <br /> X Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < 1 <br /> • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures '$350 S' <br /> Filling/Grading $150 Boathouse $500 ^ <br /> r. <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. i Ek <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. lb*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> _ o '' <br /> Property Owner's Name: 1.--)q\(;, d- !2/hA1// 2 Pr K K e Ie Q <br /> Property tyOwner's Mailing Address: Ti err Plan L ach 5�n Ia �r�l6k CA 9 s wn -c <br /> I <br /> City State Zip <<E W <br /> ZProperty Site Address: t Ma <br /> Contact's Telephone Number: 9 4 cr 53(� 6O5! a <br /> 09 d <br /> Contact's Email: e(1 C bC V Y rQ s b C )0 , I n 4 = <br /> **[f staff has a question about this application, you will b'e contacted via email. Make sure your email address is �N; <br /> legible and your email provider will accept emails from the folio ing address: @BurnettCountyWI.gov 5. °O^ <br /> Legal Description of Property: LOf"I C 5 M �g P 5 (f fi e-OTj 4 31 N l2 me KO ? (J 1 <br /> t. <br /> Section#:SZq Town#:7LID N Range#: I4 l W Town of: A-CKSO / . <br /> W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> , I Tax ID#(1-5 digit number; found on tax statement): �� 1) XC <br /> Proposed Use of Structure/Addition: /7Fi C K. C1't <br /> Anticipated Start Date: S/l}' .. (Home)Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: y Q" —.1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d z J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> 0 <br /> G Pr kvy +0 \ae reA wve,d I ab nc,cad or pe r m;>, d by 1°1112oiy r to <br /> rri <br /> cn <br /> D Pa\io -F,a.?l4- OJ€ 4o 6 („0„,fed Or 9.efMi -led Cif finsible, 6.1 ID(112L T FeeRec:/off`) - <br /> ° Check#: 16 / <br /> C <br /> m <br /> Date of staff site visit:6/234 r --- <br /> 202� initials'of site visit staff: T d �� �, , <br /> IWO <br /> APPROVED BY LAND SERVICES OFFICIAL, DATE:to ` g /zoay .co n <br /> CD fir/ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF .2 �, 070 <br /> 00 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 JJ <br />