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- . - LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ‘2"' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ` i <br /> )t Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° I. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r"' <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. `5 <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. S - I <br /> z <br /> Property Owner's Name: t.v c.1 (It IN 14......j I i c k I✓`ri o o <br /> Property Owner's Mailing Address: 56 8-6 0 f C( 3 5- R C( L 4y h`' 7 kfTt c yY3 e <br /> • <br /> City State Zip ° E <br /> Property Site Address: ' 44 ( // Q o 5 <br /> Contact's Telephone Number: 50 .3 • �C b 7 0 CD <br /> a <br /> ? <br /> Contact's Email: Kr k c_ k w o rAcf ,02--5-(d. Y7 3{vt c;t F C U M <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 °o °O <br /> 5' <br /> 0o <br /> Legal Description of Property: SE Sw 0.Section#: 0 5 Town#: 4{1 N Range#: (6j W Town of: 34-iJ1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v) <br /> 9 (,r i <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: 0 *�, 54 0 rL5 L i.II.r cI H <br /> Anticipated Start Date:_S kj I,q a O Io102.--t-f (Home/Cain;Commercial Business;Bedroom;Deck;etc.) \ N <br /> Building Contractor: A< Iki. \-1 1 a ( S Sewer Installer: /✓/ i y z.' - , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m N <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o x <br /> 0 Ill t'S 51-ru dti vet. /5 7e,t'K, "t s a(me- /o Ga 42;H 4 5 /4 °e <br /> Zozz a emu I �jo7� y <br /> tnI'�E% lO vtI'��l�y 45 S�ia�v1 H � v, _ <br /> ,, dI / �j '� �O�' <br /> 0 A)0f j 6e usue+ -6V' At, v,AaH 4 / 9 FeeRec: /� <br /> / / °z Check#: /U <br /> 3 Ca ✓ o✓'71-( r`ee.03 r1 5 a /c�Hd u 5 C- e e-V w►►7L oI^ rl ee c r <br /> Date of staff site visit: 4' ilzeg WV Is of site • •t staff:'T 4 V IL a r ,'"" <br /> % 3 M <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: &p/y/ZOZV o.a, -c o <br /> SR c <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 2 U� <br /> a 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q <br /> fiii <br /> Pagelof5 m <br /> Burnett County,WI Land Use Application-Rev 04/2024 1 �L JJ <br />