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LAND USE PERMIT APPLICATION — Burnett County, WI a I <br /> b <br /> Applicant Complete All Sections Below This Line 0' <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 y <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 'J <br /> Accessory Structure(Garage,Shed,etc.) $150, \Addition/Alteration to Accessory Structure $150 LI g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 L <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250_ ° ?0 O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 07 .,tom V <br /> Filling/Grading $150 Boathouse $500 fp <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. '5 <br /> -o Q.—. <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 /> z <br /> Property Owner's Name: _� O. ' � 5( o f o o <br /> Z Property Owner's Mailing Address: ✓I Il‘ / v f/,}-'l,�14/L lc() 61l i slq 7 t1 n <br /> City State Zip 4II <br /> Property Site Address: 2 59t)71;4,4-4(Z�.; (, J/4 f` Gi 'tiLIt f r 1-L o N <br /> Contact's Telephone Number: 7 I S 3 co 7 2- 'I -7 0. <br /> 12,4 <br /> d <br /> rA <br /> Contact's Email: P .) 1 lot" ►Z. <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: @BurnettCountyWI.gov $ 00 <br /> Legal Description of Property: 14 I 3 C-SAA+V 3 P i 6& P <br /> ` <br /> Section#: I Town#: l N Range#: W Town of:p/tA4 1 le,IS S. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* id c(n <br /> -ZN-i 0 <br /> 12_ <br /> Tax ID#(1-5 digit number; found on tax statement): o <br /> d <br /> Proposed Use of Structure/Addition:$c LK'4,4A- 02 C LC.h - 'J N <br /> Anticipated Start Date: 1 2.1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) I ty <br /> i <br /> uJ <br /> Building Contractor: IFSewer Installer: y "I V`Lt <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> v, <br /> — (kik CAA 5 'pa,�,� x <br /> A <br /> Fee Rec: /1 <br /> ° Check#: (fIR� <br /> z <br /> r. <br /> A,- <br /> mg <br /> Nil <br /> �o <br /> Date of staff site visit: 1)IA j�c1-'k Initials of site visit staff: 6L 'i�Q.CD = 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: &At "lQ 1NKU/ DATE: `IZj2a22,4 a. ffl <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF fl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CDNil <br /> Page l of 5 Lt.... JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />