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LAND USE PERMIT APPLICATION — Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line 0 ' <br /> Permit Types and FeestP/eose,check appropriate boxes) <br /> C A Dwelling/Principal Structure $300, Addition/Alteration to Dwelling/Principal Structure $200 F, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> X. Accessory Structure(Garage,Shed,etc.) $150, Addition/Alteration to Accessory Structure $150 �, <br /> NX <br /> ' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> , <br /> 0 <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. ' a <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 /> Zr.,: <br /> a <br /> Property Owner's Name: 1 �.y,,�, S.2a. r r j 1 0 .NC <br /> 0. <br /> Property Owner's MailingAddress: OC as L A / d �� 1 ���i/ J'51c�-�0 1 1 <br /> 1? m Q z Ctl1 n J o En 4 <br /> I City _ State Zip <br /> Property Site Address:,'(?"/ Ltz.k eS 'DR ' .n b u rj 1 CA i j 5 '/ W,..3.0 o N I <br /> Contact's Telephone Number: 1/80 , ,a 9 7 - �(a 1 9 a. <br /> / co <br /> d <br /> Contact's Email: C..cc.l'S/u -r r- i ��r`t 5 n 0 e ',pl.? CD <br /> **If staff has a question about tl%s appli ton,you will be contacted via email. Make sure your email address is N C <br /> legible and your email provider will accept <br /> L7 / <br /> emails from the following address: @BumettCountyWl.gov / 0 0° <br /> Of N <br /> Legal Description of Property: to �1 / _i �i r�i t n �ut'� 55 e S�y r �tu- . h, <br /> Section#: (-2 7 Town#: y/ N Range#: /,S' W Town of: Sc.v,.s S 5'. s <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> N -t o 5 <br /> Tax ID#(1-5 digit number;found on tax statement): `a a 7 7 <br /> l / 5Proposed Use of Structure/Ad .tio . /7 a M e- —� <br /> �' "� (V <br /> Anticipated Start Date: 6/I r�'y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) tV <br /> II Me5 <br /> Building Contractor: 3ilia n LA cued ewer Installer: K. riS `A ' 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONIITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: opo <br /> m <br /> Oak+ all Sc-I�oucks v\ <br /> ri <br /> pDIALLial no +o -exatd 2 beds- "S P`'' SIN' ZN-MytiD <br /> y ` <br /> Fee Rec: h r <br /> CI"`a'ra e US`� 7 r , ID-(-1- i.' {, s 1 to/ °(�'`� 1✓l , aim, "I z Check#: r t <br /> au At°'( 3,t-HbwJ • m <br /> V bairj5e CR n rlOt urLd -Fpr 1r1tA.11,10.41 kcd '=1-a+0 �J <br /> II C Q <br /> Date of staff site visit: 30 2-OZ1 Initials of site visit staff:+ 64 -i 1 <br /> APPROVED BY LAND SERVICES OFFICIAL: i� ����� DATE: /(i/2�� 7 m W D <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 0 Inni <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N <br /> CD FEI <br /> Page l of 5 zI <br /> Burnett County, WI Land Use Application—Rev 04/2024 )J <br />