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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> 1 g 'fib <br /> Applicant Complete All Sections Below This Line o 4. v <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 E NI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \n <br /> Accessory Structure(Garage,Shed,etc.) $150 J( Addition/Alteration to Accessory Structure $150 P. <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G' p <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 'vi <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <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. `. <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. I- "" , <br /> z <br /> Property Owner's Name: I70 n/4. 1 S)z l T2 o <br /> Property Owner's Mailing Address: //4 q 4 L a P&p, I.t r5 i eai 60'4.776 K "fll'i Sq�`O 7 n <br /> City State Zip ° c <br /> Property Site Address: 5A11 -e o N <br /> • <br /> Contact's Telephone Number: 7 /,S - Cc&?- 2,/ 7 3 ro <br /> K <br /> Contact's Email: (i-.o N-f <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 c °O <br /> ao <br /> Legal Description of Property: `j Lu Ne�a d <br /> Section#: ? Town#: -3 7 N Range#: l? W Town of: &(.) ( Thn Ps 6 / jl m' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v) <br /> Tax ID#(1-5 digit number; found on tax statement): T74j9. v u, <br /> 6- <br /> Proposed Use of Structure/Addition: Otr-) ACC. l_ Le- -3 rJ <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) J <br /> Building Contractor: Sewer Installer: „, <br /> 2 A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> n <br /> 43- Fee Rec: I5 O — <br /> ° Check#: <br /> z <br /> r <br /> -C <br /> q <br /> m <br /> rc <br /> vJ <br /> Date of staff site visit:")/11 I W7.1"1 Initials of site visit staff: hL a n In <br /> APPROVED BY LAND SERVICES OFFICIAL: LAX DATE: -2 1 t7/Zovi Cz W „I <br /> 0 <br /> CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y _ Ed <br /> a0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q <br /> z Fill <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 Lc-------)) <br />