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LAND USE PERMIT APPLICATION - Burnett County, WI a I <br /> Applicant Complete All Sections Below This Line 0 0 <br /> Permit Types and Fees'P/ease,check appropriate boxes) 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ° <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 lr` O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure _$150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 !3 Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> • <br /> Filling/Grading $150, Boathouse $500 <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. `2 <br /> ro <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. <br /> z � <br /> Property Owner's Name: R I Lk Ck rot Kri L' ►14 Z. j� o t' �1 <br /> Property Owner's Mailing Address: 3O I-/P© 'rA li or`et e i' /J� 4i�t 1'`y WI s V810 T n °0 <br /> City State Zip ° ') <br /> Property Site Address: 3dNeO r7-d4nf Lc'-cke d/; 6 4-Ai / WI. S ygS'O o_ N <br /> CD <br /> Contact's Telephone Number: 3:2_0 9 t'Q S 2 3 a. <br /> Contact's Email: A I( L vh L 0 4 c r/1/ct% I CCU/IA <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: @BurnettCountyWI.gov 0 °Q W <br /> o' <br /> Legal Description of Property: Sec : 1 i TN yI Rl i5 Lc C' C.SI04 ✓2Z p.29f (4 ?9j�v/y)(A®it, p <br /> Section#: I 1 Town#: `-I i N Range#: 1S W Town of: 5 f,,,,i 5,5 <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): 3 2 (p©2._ V ..D i <br /> ci <br /> Proposed Use of Structure/Addition: &tl 214 Gk= /Sit G'P v4 <br /> Anticipated Start Date: th A,/ a C'2(-i (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C , N <br /> Building Contractor: Sewer Installer: y L o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> o <br /> D Mej al ,- JS <br /> ' �� Ib�fadCA <br /> No �� - > <br /> !' Yc Fee Rec: I <br /> z Check#: �i <br /> r <br /> -C <br /> x <br /> R <br /> m <br /> m Jl J <br /> Date of staff site visit:513040224 Initials of site visit staff. is 4-l/L 3 0 11 u u <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 1.6/202q cc)co y,„ 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 a <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> co Hil <br /> Page l of 5 L.L. JJ <br /> Burnett County,WI Land Use Application-Rev 04/2024 <br />