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LAND USE PERMIT APPLICATION - Burnett County, WI a § <br /> Applicant Complete All Sections Below This Line o' 41. <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes), 6 C7 ... <br /> Dwelling/Principal Structure $300_ Addition/Alteration to Dwelling/Principal Structure $200 <br /> V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4 <br /> 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 _,A. /$250 ° G. <br /> �' Driveways/&Campground Structures $1 t�e�i� y�ly tkuc sl . ��i $' ! o r <br /> • <br /> Filling/Grading 150 Boathouse $500 1 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a i <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. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 4'j ' . <br /> "C o <br /> Property Owner's Name: 417 4,1.I A Or tr"1i -'PY - /fLlD'J R o st..) <br /> o <br /> Property Owner's Mailing Address:52l . 4 4�f.Z/#, P ficivlji9-!'ol.PA Pt- 3Ja? 5 ' . n <br /> p City State Zip ckp <br /> Property Site Address: l ) CBG( /r? AZ�io /7II. I ifri5z eitK 1 59I50 o c <br /> Contact's Telephone Number: 2&4 3 7 ! v /;3 0 0 Q ,.a. n <br /> Contact's Email: b/ l f/ CI"1/1 erg phi°` 2' � J' <br /> **If staff has a question about this application,you drill be contacted via email. Make sure your email address is .iZ" <br /> N <br /> legible and your email provider will accept emails from the following address: @BumettCo ntyWl.gov o ao <br /> Legal Description of Property: lam{ z GS14 v ' 2-3 AE, d w <br /> a <br /> t' !' LI g <br /> Section#: �'l Town#: '!� N Range#: �1 W Town of:�Af'�" '"' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> ( g ) 7 6-7 3 (0280 N <br /> Tax ID# 1-5 digit number; found on tax statement): —/f- -�i ir--/ L ,, <br /> Proposed Use of Structure/Aditioln: S7' IJ 7`� ram' -_ (Qlw -a c cJ: <br /> Anticipated Start Date: 7/ I/?i/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> < l 1 p x a .rj <br /> Building Contractor: S/f UL X PP 0 f Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Pci <br /> l-(lS t"LA '71— /S elf/y i 'r -- 5 4i1'S a n c re e S4vl cr/'/ < '� <br /> IctiAcitrIa) i)19eS LW—lH (U� <br /> G ( 0Xe— O (9vtcGttt�lj. cFee Rec: L co <br /> ° Check#:f <br /> z <br /> r- <br /> jt\14i'? . <br /> 124.Q' <br /> m <br /> rr cn <br /> v <br /> Date of staff site visit: -3 I-001)t I ' ' Is site v' ' ff: VL I iT a <br /> APPROVED BY LAND SERVICES OFFICIAL: -- DATE: //0OZ CD c W C°'> <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> Page 1 of 5 _-7 <br /> Burnett County, WI Land Use Application—Rev 04/2024 -% <br />