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LAND USE PERMIT APPLICATION — Burnett County, WI cr R <br /> a <br /> d <br /> Applicant Complete All Sections Below This Line 0' c A <br /> Permit Types and Fees�Please,check appropriate boxes) CD I <br /> °' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 f,, ,v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ......1 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < C' III <br /> Driveways/&Campground Structures CIP <br /> WI State Statute 59.692(1v)Structures $350 0' 0 <br /> Filling/Grading 50 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. <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 /> 0 <br /> Property Owner's Name: 1.}/✓0 c24-:�[f tc.. s`JC A,P =' <br /> o <br /> p a. <br /> Property Owner's Mailing Address: ,2- y>G[ S/- 4 .3i_ -j E-- i-'i j v O J 3 E n <br /> City State Zip ° E .. <br /> Property Site Address: Z.,' :5 ei y f41 6 5 f e)0 Pir 2 C o1111 <br /> � �J c <br /> Contact's Telephone Number: 7/s- )ki- vZ/ 7�A-i4/Q. na. <br /> Contact's Email: i C A to R 4,14 no-r et., L o C e rvl CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N „ti <br /> legible and your email provider willil accept emails from the following address:es @BurnettCountyWl.gov S <br /> cro <br /> Legal Description of Property: G 4/ce / C9M lit /p/ 2&9 d rN <br /> Section#: Sr Town#:90N Range#: / y W Town of:Tar2 'r 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 /> g.-77 <br /> Tax ID#(1-5 digit number; found on tax statement):_ — I " <br /> C <br /> Proposed Use of Structure/Addition: . lee, .3 <br /> Anticipated Start Date: cf-� 2. —0219)2.y(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) , n <br /> z yr <br /> Building Contractor: Mtn r e 14) Q. Sewer Installer: cn oQ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> D Deck- off/y a//oWeJ ID be 7,s - otA - IAA tile. <br /> rii <br /> J Fee Rec:425--Ol b e-x. '2-W1 pi- -Roo 4(c7/kit' per 2 Z "/74 z Check#: 4454„ <br /> 5 <br /> m <br /> m J <br /> o r <br /> Date of staff site visit: c/3 O 2�E Initials of site visit staff: K t /, ac. ll u <br /> m 2 <br /> APPROVED BY LAND SERVICES OFFICIAL: /�.e-- '_ .DATE: �//ZOZ y ", "c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 N <br /> z Fa <br /> Pagel of 5 LC____ <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />