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LAND USE PERMIT APPLICATION — Burnett County, WI a `° <br /> Applicant Complete All Sections Below This Line 5. <br /> Permit Types and FeesPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Y Addition/Alteration to Dwelling/Principal Structure $200 `n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° W <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 nG.. <br /> Filling/Grading $150 Boathouse $500 1 <br /> ? <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. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. O <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o T <br /> o <br /> 0 <br /> Property Owner's Name: i 1iv S ra, } ) i4 Sc+Nl o <br /> 0 <br /> a <br /> Property Owner's Mailing Address: 5 3/7 jehizo eiv Sc.,. I"1 PAS yri) 5.514)0 E. <br /> 3593 City State Zip i d <br /> Property Site Address: O ' ' o i <br /> 11 <br /> Contact's Telephone Number: '?/s-—735—00)Z. °' <br /> Contact's Email: e ea pt:,i,--c�O'{O yftWu+.('"i <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 <br /> °q <br /> 5 <br /> co <br /> Legal Description of Property: Lerr 2 eS&'N /„2 I VOL- A9 P 73 L 13?2' 6 Lo 7-3 0 <br /> 7, <br /> Section#: i'4 Town#: CIO N Range#: I"? W Town of: U hC ) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7 cn <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): 34 0 3S' i <br /> Proposed Use of Structure/Addition: H`ie--(4 0 jt, at,Aile) —i w <br /> Anticipated Start Date: 6OltldTDa(4 (Home/Cabin;Commercial Business;Bedroom:Deck:etc.) Z or <br /> x I C) <br /> Building Contractor: 2D,4) k14L..0 cJ &t Sewer Installer: D W <br /> cn <br /> 04 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> DN4Q-0- Uni-Enrnvl Dim,(,�,i Cod.0 Luc fa--ham -b �� a Per/nil-f <br /> IS fete itcl rn <br /> F <br /> 20 RO-A,kn lrl) Walk 4D f2nfOrtA Or VaAanc-e a Plitd -6r by 7/go/Z°Zq Fee Rec: et) <br /> Q ° Check#: al <br /> CU,fhold aqd come)-etc mA lcetim ?Win bk-f I3IWv-I { <br /> rrl <br /> rri <br /> Date of staff site visit: 5/81z4 Initials of site visit staff: �r � w W � <br /> APPROVED BY LAND SERVICES OFFICIALC% V ATE: 6 lio' q l,C 1J <br /> ;I-% 1,-, [Full <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 CCU o <br /> N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTtin <br /> R. <br /> Page l of 5 �L, Jj <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />