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LAND USE PERMIT APPLICATION — Burnett County, WI c r <br /> - b <br /> Applicant Complete All Sections Below This Line 0 4. <br /> PerlCTypes and Fees(Please,check appropriate boxes) a <br /> Y Dwelling/Principal Structure $300_ Addition/Alteration to Dwelling/Principal Structure $200 . 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150_ Addition/Alteration to Accessory Structure _$150 �, <br /> Accessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Ill <br /> Driveways/&Campground Structures $125 — WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 , <br /> Solar Panels(Stand alone or roof mounted) $150 )JPermit Extension(1 Year Extension-Allowed Once) <br /> _ $100 <br /> go <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `' <br /> ro <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. o <br /> , i <br /> Property Owner's Name: ro 1� -V v'. \ � o — US <br /> n- . . \ IPoWNst4ACk <br /> d n NProperty Owner's Mailing Address: 7j� �.v.) /'CV`C, lv MO 552� �. N <br /> L " City State Zip c0 -L <br /> Property Site Address:M(1-6 e! it,1\1....0h,/?-1V-47 1XXa'W , ‘ <br /> Contact's Telephone Number: "I(P? - 331 - 5A 5 N c N <br /> ol v <br /> Contact's Email: Sp Y\��51 c� C vv isli .Y\,�k <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N N <br /> legible and your email provider will accept emails from the following address: @BurnetttCountyWl.gov 0 °O <br /> on <br /> Legal Description of Property: . 2.Qi � <br /> (5+r vi✓ -\ Ce,, cal 1^---\-k ^ - (4,1 p O_ <br /> ii 0. <br /> Section#: 0-1 Town#: iit, N Range#: 1 (D W Town of: QC32-‘64\ W <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): .54 A t.Aa <br /> d <br /> Proposed Use of Structure/Addition: -- p <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f <br /> Z d t <br /> r <br /> Sewer Installer: `� <br /> Building Contractor: c4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY `n z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: cpv <br /> V-11/lA S (S Gt 1 VD,r T - rn i+ ,tX-4e,.>n.S tan -Far l i- 23-if t`1 <br /> Fi <br /> 2 �,,, -I vl <br /> m �y-� <br /> (c) biNxlicAn1 h04 -1O kX-Mt :J { A� UPS S �5 'ZZy > Fee Rec: 1(N�'1? <br /> b `^" ITC t)C(e ecl y 0 61 f- "$+Yl lii t a() z Check#: '© <br /> Date of staff site visit:7/2 II0V-i Initials of site visit staff: G(-i V r `— Slid <br /> U <br /> //' ,, C, <br /> APPROVED BY LAND SERVICES OFFICIAL. . t{9 7Z DATE: 7 AP 2-D24 <br /> c" aros <br /> m .. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF °_ r.o. <br /> o <br /> c4 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT * Bit <br /> Pagelof5 L.:L .2) <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />