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LAND USE PERMIT APPLICATION - Burnett County, WI gr i <br /> Applicant Complete All Sections Below This Line 5' <br /> c. <br /> CD i <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co x+ <br /> Commercial/Industrial Structure ,$300 Addition/Alteration to Commercial/Industrial Structure .$200 ;...S 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 � R <br /> y/ Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < M]` Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c 4, , . <br /> Filling/Grading $150 Boathouse $500 <br /> d <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> iv <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 1 <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o �� <br /> �/ � \ t ( _ ° <br /> Property Owner's Name: 1 1 �Q J l o <br /> + 0 <br /> Property Owner's Mailing Address: Q. a'1- I V--.I 11CC1rQ. R0(1ba yLb.ihl{ lt.r1154 fez77 <br /> C) <br /> City &Ate Zip <br /> Property Site Address: a I YY\Q., c ti <br /> Contact's Telephone Number:-I l S -.1 3 - OLo4A . <br /> P. <br /> Contact's Email: �f\1'—4ZI,L@ ha--r-c I •Corte arvtJQC1,Ne 1 .C6'~` <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 z, °0 <br /> ao <br /> Legal Description of Property: So U 14•1 11,.:). ` CSection#: Town#: -40 N Range#: 1S11v)C0overivv.e.A....4- <br /> Town of: JCC,Ls 61,--, ,.� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* J v) <br /> � <br /> Q^� l " o <br /> Tax ID#(1-5 digit number;found on tax statement): --�"11`V v� t I d <br /> Proposed Use of Structure/Addition: (IC— -3 <br /> Anticipated Start Date:Pe:V (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) i i -R <br /> Building Contractor: Sewer Installer: Kpi <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v <br /> r Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> l 40 pill Skc - '(`P,ii,Gw`f`C rwP.wk-s < Vt <br /> F <br /> m <br /> v, <br /> i-ii (�) <br /> Fee Rec: <br /> °z Check#: 2,ii>- <br /> •C <br /> m <br /> n <br /> Date of staff site visit: (id)171).'lli Initials of site visit staff: ( L-- flfl <br /> APPROVED BY LAND SERVICES OFFICIAL: by' DATE:--7/3) 41 CD)Ea 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N o -� �'� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT is:.) <br /> Page l of 5 3 <br /> Burnett County, WI Land Use Application — Rev 04/2024 , ��1 <br />