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LAND USE PERMIT APPLICATION — Burnett County, WI cr <br /> N N <br /> Applicant Complete All Sections Below This Line 0 <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :l' i <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200p ,Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150r,Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> ii <br /> Filling/Grading $150 Boathouse $500 <br /> to <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun) may cost up to three times the normal fee. `1 <br /> ro*Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> r g tA <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o .- <br /> z <br /> 6 <br /> Property Owner's Name: 74 p/7�((g' I- Ss OA plat <br /> o— o p <br /> Property Owner's Mailing Address: t 3 l�J £ )Li,?/'y A20a I/fp w e g-er' bvi ( ' 95 ?' C) 4 <br /> �2 �- City State Zip <br /> Property Site Address: 30 6.5* y ;dr Ly'l to � ------ o y <br /> Contact's Telephone Number: 7/ �j/�(p '3y(J7 n. <br /> Contact's Email:_ �`(r� e g/11 abI #C�'r <br /> **If staff has a question about thition,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: ( BurnettCountyWI.gov �. W <br /> IIA�'' �j c L 5 <br /> 0,1 <br /> Legal Description of Property: -.I.4)) I)I JL�/U6 P <br /> Section#: el _.Town#:_ 4-1( _N Range#: I W Town of: 5Wi‘5S - <br /> *Attach additional page if needed,for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> / L/ � x <br /> Tax ID#(1-5 digit number; found on tax statement : 7</) tP 7` �-NC <br /> 0 <br /> Proposed Use of Structure/Addition: 7,/ 51/1 it/V, CS e � -�/ ", CA <br /> ry <br /> Anticipated Start Date: _ - )6 • C 7 (Home/Capin;Commercial Business;Bedroom;Deck;etc.) . `— <br /> U <br /> d� , t1 <br /> Building Contractor: Ili C lr _ Sewer Installer:_ �--_ tn <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v pc <br /> mi <br /> Noy- -lo I¢e used iror hu,nutill 4 <br /> "1 (� �n0674) . /� L Fee Rec:$I5C� <br /> 01-rhis paa.e f is (AST '�tzbeviDu Sw-face 'vla � t Qua 11'►ipt1'unm If z Check#: W el <br /> till r ep irr -iyu-i i <br /> Date of staff site visit: /c?/z1J Initi is of site vi 't staff:cT 3 W <br /> cz c <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 2 � , <br /> UPON APPROVAL: APPLICANT M ST POST COPY OF o c Na <br /> a) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ; .. [N <br /> Pagelof5 L - ) <br /> Burnett County, WI Land Use Application —Rev 04/2024 <br />