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R LAND USE PERMIT APPLICATION —Burnett County, WI c r <br /> b <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees'Please,check appropriate boxes) n' <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Rl 0 <br /> Commercial/Industrial Structure $300 ,Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ..C% <br /> Filling/Grading $150 Boathouse $500 ,, <br /> cn <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 /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. I. <br /> *Items*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> _ / z <br /> Property Owner's Name: � ✓L� -1 c t �14 �?,q( \0 <br /> Property Owner's Mailing Address: E/ 6 $ 5 'et Rd `4'4 7 e....1 ''" w , <br /> � � O 5$�t)116, <br /> City State�Zi i C <br /> Property Site Address: �j 1'� �z' ( `.�. <br /> Contact's Telephone Number: 577 Irk <br /> ` I `�Contact's Email: l ' erj& — l ?//r ,d_l t C <br /> **If staff has a question about this application,you will be contacted vela email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0 00 <br /> • f- / C-51^A 5' W <br /> Legal Description of Property: _ U. 3 2 Apr 33� d VISection#: �� 7 Town#: e) N Range#:_� W Town of: --1 kse--'l`' ff. ` l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O cn <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement)::Q_ 9�Z \ <br /> Proposed Use of Structure/Addition: 2i tek7inX44 y \ �l <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 <br /> //�__ <br /> Building Contractor: %`Ce ✓C/ S Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° <br /> z \h <br /> THI PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:nie,-„90 26`2, <br /> z po <br /> v <br /> .',' \i) N <br /> 0 fdoto 4ii co,,4540i1S IM V f1g-ZY-/s. CoHTc„G/- n <br /> ri <br /> cA <br /> ill/ /'100/"e- / ie- Goii Se-e `a/-/rem c /V ., il. FeeRec:SIZ� <br /> / ° Check#: 29 q3 <br /> -G9r W11Y-►' G ON k\e�'U 1 re m �S. -< <br /> gD,,.)e/1M Hot 3 b owls/ V 5041'7/ovy <br /> ,` �A <br /> Date of staff site visit: CO�9/ZD Z 7 Initials of site ' ' staff: JA/Z--- a <br /> (APPROVED BY LAND SERVICES OFFICIAL: 9 rD <br /> DATE: /l� Z l m c° <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> 0 CD <br /> 0 0 = <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> C3) /)Jc '�/oo Oil 04 1 Ir110rIAA0n0,1 15V Surge'/" Page 1 of <br /> by 7l(g/zo Burnett County, WI Land Use Application—Rev 04/2024 J. <br />