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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c <br /> CI. <br /> Permit Types and Feese/ease,check appropriate boxes) � ^� <br /> d Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,. I <br /> � <br /> ri) <br /> 5-1 Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� 71 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° OJV <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 'IK r <br /> Filling/Grading $150 Boathouse $500 n <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. l' <br /> ro*Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. a ...ik <br /> 11, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ' <br /> o i ' <br /> Property Owner's Name: rr S —' j: L. <br /> Property Owner's Mailing Address: ES 5-7 X\, <br /> 0(Ni t l 0‘ . `U, �L � ' F. N VJ <br /> n ,,, ( '-� City State Zip <br /> Property Site Address: o' O k� t�-y�'Q ��1,\\ o E <br /> a <br /> Contact's Telephone Number: `'Z 6-' a <br /> �- Nd <br /> Contact's Email: -CS� � 6 E1/ `' <br /> **If staff has a question about this application,you will be c cted via email. Make sure your email address is N ro <br /> N <br /> legible and your email provider will accept emails from the following dress: @BurnettCountyWl.gov 0. 00 N <br /> 0 <br /> Legal Description of Property: /4- - Wr) S �vU ( '' .% tic <br /> Section#: 08 Town#: 140 N Range#: 1 1p W Town of: Dc k.(0.rl d q' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): ILI3 07 �' °� <br /> C7 Proposed Use of Structure/Addition: ( poR H - <br /> Anticipated Start Date:COMp1L-11 a (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) — <br /> Building Contractor: Sewer Installer: Ln <br /> c <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rn <br /> a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> 01 24 OA Srt,-1bc S `�F <br /> ®Noy -ID be USe d 1or hwrn ► cn <br /> cn <br /> cA <br /> a Fee Rec:3C..O <br /> 9Check#: 9 (t 7 <br /> n5 Oca <br /> Lk41. )/2o <br /> rn <br /> Date of staff site visit: I I /1014' (IInit'als of site visit staff:�4- 5L�- _ ir <br /> APPROVED BY LAND SERVICES OFFICIAL: /lQdvt0 DATE: 12/,02y < m = C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF0 0 C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 fL ; <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />