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LAND USE PERMIT APPLICATION-Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o CD A <br /> Permit Types and Fees(Please,check appropriate boxes) .�" C7 <br /> w <br /> IDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Z4p <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' <br /> Filling/Grading $150 Boathouse $500 .A <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> co I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `& <br /> .-o*Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> o r>.".1 <br /> Property Owner's Name: I/J /&- J2 1/I.L L t C /0 O/1 8 <br /> Nip <br /> Property Owner's Mailing Address: .23 9:S / A'+ C&W/Z e. R td. tjti a66.,A y i .r_ S"31 SI 3 i,' E n <br /> City State Zip E <br /> Property Site Address: ,$"/91`7 6 Z c r <br /> Contact's Telephone Number: ('7 3)- 7/6 :/C' 2 9 A. <br /> ii <br /> Contact's Email: C�A /�//. 1/O o i //etc,•AT M L/r' c Lc,/ <br /> **If staff has a queson about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov =. 00 <br /> 30 )v,, i CRA'h N "1)40i re'er'd •fcv Ut>y,46i 4 /,'/,f4RC+ �' <br /> Legal Description of Property: oct r C o r / s,1/Jr/.EA /4: At-3 2/33 4 P. <br /> Section#: ©/7 Town#: T v N Range#: /4/ W Town of: ,S C 0 7-7(e -) <br /> i� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): /9 d 5 J d <br /> Proposed Use of Structure/Addition: .5 re)' .4CL -4 c/l S� <br /> Anticipated Start Date: `7//( /2 >, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) yJ <br /> d <br /> Building Contractor: tea:efrqt,en L/ 4,'9L' Sewer Installer: /V�j} y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 3 <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v x <br /> -Audr la1 5sdbalk. ,rc,glaokS <br /> Fi <br /> rri <br /> - Klee v W- U 6mikh% 6.15:+w+a,n y <br /> a tf <br /> Fee Rec: 1,�" <br /> ° Check#:724,/4,3 <br /> ;o <br /> m <br /> rn <br /> Date of staff site visit: 7) «I2ov-t Initials of site visit staff: V1.- <br /> n <br /> APPROVED BY LAND SERVICES OFFICIAL: 440A/ttyinativ DATE: 7/1I J20i' `•3 <br /> m aO <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o `. <br /> 9;•Z ry <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I Lit <br /> a. <br /> Page 1 of 5 (... J.i <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />