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LAND USE PERMIT APPLICATION- Burnett County, WI a <br /> -d <br /> Applicant Complete All Sections Below This Line 5 <br /> a <br /> i Permit Types and Fees:{Please,check appropriate boxes) .- <br /> d v\111 <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 S Oq <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,.1 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ‘iv ry <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ee. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t- <br /> Filling/Grading $150 Boathouse $500 Cl) <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 -. <br /> i. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ,ti e---. r <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 /> 7 '1,N r <br /> Property Owner's Name: l3Q\t V N•\S*rCL.r � <br /> a <br /> Property Owner's Mailing Address: 311s N 00,Y, O.V‘fte_+ CI'TOJNiS A.TC\ W i 54 ts4 °' <br /> 0 n <br /> CityState Zip <br /> Property Site Address: 1 D L4 V1 -CK4•t_. 'GLd 10 SWYtr W\ 5 y 1 a a <br /> n <br /> Contact's Telephone Number: `A\ S- LI 31 - 005 S a <br /> m <br /> Contact's Email: C0.ge--Q off oxV'\S'Dwrs COM •'n2.4 s <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov _ tl° N <br /> 5" <br /> cm <br /> Legal Description of Property: 7 <br /> Section#: 19 Town#: 3 8 N Range#: 1-1 W Town of: �Qt(\ CX S a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* J l y <br /> 2' E j �' g <br /> fax ID#(] 5 digit number;found on tax statement): t7 <br /> Proposed Use of Structure/Addition: He) et e y O <br /> Anticipated Start Date: (Home/Cabin. Commercial Business;Bedroom;Deck,,etc.) A t Ant I� U l e� ` <br /> BuildingContractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CON'IMF.NTS/CONDITIONS ONLY r 7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: › Pc <br /> 7.@ fAtt+- CO k-Italk i4; <br /> -214-1% <br /> atl,,i0A) p i- ko ttue i 2 c�ro�mS lvD <br /> q mac, 1_. Y � Fee Rec: <br /> 3 Only one dvAiitAc) ouowad 0.M.\ ' t tk 4-tiN 1 d � ""/ D� Check <br /> �;,.� Im;� bN 12�31)2o25 oR _I< <br /> Dr CO (nVi -Eo 0.c�esso��{ Sink(-lurt x <br /> farce-1 4o be 5f 114 uSi r1l de,r,s ity d`t‘itPn1 + e'rtav�5lor."‘ <br /> r <br /> rl <br /> ijDate of staff site visit: 6/Z6M lnit'ais of site visit staff: �4 w-r _i l <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: lid/ZD7i`7 n ‘.. Ertl <br /> CD C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF — <br /> ffil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g <br /> Page 1of5 5 .4.;'' <br /> a) Irifil <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br /> L JJ <br />