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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> b <br /> y y tJ <br /> Applicant Complete All Sections Below This Line 0 a <br /> ts <br /> Permit Types and Fees(Please,check appropriate boxes) 'a <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> / ` Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> $250 CV <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500c..] , <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100g. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. q n <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. pp <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o lb <br /> 0 <br /> Property Owner's Name: 72,E(.-f OE_ P. /Ni tLi E g r <br /> �1 . <br /> Property Owner's Mailing Address:( 32 4/ E. /)uk SNoILE �z S r�‘�LF/c(0 /I. ,Z�/Z n <br /> City State Zip ID.'" <br /> Site Address: '7 t� S �h!+ .�ds77 Lfi c r <br /> Contact's Telephone Number: 7/c- ??.3 �- o cp z 9 00/Qw+'�6Y7�Z�/�ere_it., <br /> �,u d <br /> Contact's Email: CA/u E I-L (. g i U r PS /r/0 z -I . e°H <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> o <br /> legible and your email provider will accept emails from the following address: @BumettCountyWl.gov . <br /> Legal Description of Property: "j 6 T 7L1 c!(i C'r2 b - <br /> Section#: Town#: go N Range#: 1 l) W Town of: oaf&rid N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . Z!, c o � <br /> Tax ID#(1-5 digit number;found on tax statement): (?j cp3 7 b <br /> Proposed Use of Structure/Addition: A¢/2_/¢ E H <br /> Anticipated Start Date: 7/a,2. 4 (Home/Cabin.;Commercial Business;Bedroom;Deck;etc.) , <br /> CI L L141\ <br /> Building ContractorT4 U c g5 /Co,Z -- S77ZLf Egg cer Installer: .4./ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Pi z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 8 <br /> Off te,-1- 4,0 ce,-HotaS . , <br /> Ei <br /> Nod *0 1oe US-Id h U maw Ikcabi- <br /> Fee Rec:� f, - <br /> 3 Check#: 3 n3 r� <br /> / C� <br /> Date of staff site visit:I/Z t l t'4 Initials of site visit staff: (,Le k 1 t1 n L <br /> DATE: 0 % @'w C 0 <br /> APPROVED BY LAND SERVICES OFFiCiA��_-��k I� �j�j 1 <. � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y . USN <br /> 0o <br /> 0 <br /> CDC cc <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT }} ' <br /> 3 <br /> ro <br /> Page 1 of 5 3jj <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />