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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> zEA: ro <br /> Applicant Complete All Sections Below This Line 0 <br /> CD• i <br /> Permit Types and Fees(Please,check appropriate boxes) ° <br /> • d t,„, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r r <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V Q <br /> Accessory Structure(Garage,Shed,etc.) $150 x .Addition/Alteration to Accessory Structure $150 = <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 CD <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 • `\ ICI <br /> Filling/Grading $150 Boathouse $500 <br /> w AD <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 /> *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. A <br /> z <br /> Property Owner's Name: N' <br /> p rty 7-e,r/`Gna[. W 7Ac,rviirt-L 4✓.0ri)1 o <br /> IbG Q. 'L 1 <br /> 00 <br /> Property Owner's Mailing Address: 7 by3 y i nl a n 4,4• S CA &G 610,A-c- inn, j_s e)/is E. n „C s <br /> v City State Zip c J <br /> Property Site Address: ',Tyr Iu et rin') itcl, LAtbc er o N <br /> CD <br /> Contact's Telephone Number: b 3_/• 31 J.73/5/ °' <br /> d , <br /> Contact's Email: '4,,,,`1 r,f /7 3i/ Q q,ri a,/- G om C'D <br /> • <br /> **If staff has a question about this applicatidn,you will be contacted via email. Make sure your email address is N „` <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0 b4 �_ <br /> Legal Description of Property: C.d r a ,\GI tV et 'S Aid,4, ()r b <br /> Section#: 9 Town#: ,Pt N Range#: j5"-- W Town of: c �c) f 1 e- Ae 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . ' <br /> D o <br /> Tax ID#(1-5 digit number; found on tax statement): /0 o.3 Ll — -9 <br /> Proposed Use of Structure/Addition: 60 e-m : .a G <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,-3 EV4 6▪ \ 51.1 <br /> x <br /> Building Contractor: Se /, Sewer Installer: <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> c r e1+ � s.- S o <br /> m Cn <br /> (2) Igo-i_ 4-0 beut.c1 �,unwA hcI � r q�' I a <br /> P-111 ,� arcd I S ct+ I m S SU,r-act ma k (i5 .S '" k �,, h,�re o Fee Rec: }150 <br /> I r. r Check#: (00:7 5 <br /> m <br /> rri <br /> o <br /> Date of staff site visit:-I it-ter i Initials of site visit staff: ($1-' V,� Inn <br /> APPROVED BY LAND SERVICES OFFICIAL dtL/ J J�,"7/7-n'`--- DATE: 7/2 /ZOZ '1 F- n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF i A Z. [nr <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Pagelof5 2 Iiiii <br /> Burnett County, WI Land Use Application—Rev 04/2024 L ) <br />