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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> z N <br /> Applicant Complete All Sections Below This Line 0 +� <br /> Permit Types and Fees(Please,check appropriate boxes) I a LA <br /> O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `c_ 1 C <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I o V <br /> .I <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 ', <br /> r <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 'i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 °e° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 I i <br /> Filling/Grading $150 Boathouse $500 i ce (b <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 b z <br /> o Property Owner's Name: P}r%rr e, (0 et h,a.-) -711 Lr ' ill lb <br /> Property Owner's Mailing Address: 2 (s, 3 3 6 i. t S M ras-} {.f"i, ,<- wI c'LI 3T w. <br /> �($bY y(tr5 Lr% Si ren City State Zip ,� <br /> Property Site Address: Lot S 1 W" 1.44._0 28:C\ ) ,re-et , W :k tit( `►5? 2 o y <br /> g <br /> Contact's Telephone Number: I1 6-'31 ( - C►p')-cis O Q- <br /> Contact's Email: Cinn;,, AESc.Tcfir)anit-; C.t r . <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 8 00 <br /> 5 <br /> Legal Description of Property: 1,42,-'1-S C-S)-k S 3'-1 4.3 tf 30 3( 7_, <br /> 5. <br /> N <br /> Section#: I C Town#: '2,3 N Range#: 1,`- W Town of: ].t Fe;a N-e,_ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> * <br /> o .-i <br /> Tax ID#(1-5 digit number;found on tax statement): . 3 6,ej O 5 H �G' i d <br /> A C�1 <br /> Proposed Use of Structure/Addition:_ Re_��e&��O�'►�S.h�'�� a ,�Gi_' <br /> Anticipated Start Date: (Home/ abin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYr. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 8 <br /> 0 fl ?e+ at se,-NHS c. <br /> haxvra,n ka-0/ � m <br /> Q No+ 40 be U,Ged -fir y <br /> ®Calrlf 1 d- kit nab 4o b.e (gal ,►lore - 't.a-' 30 days 14 Che ke#: CCr <br /> a calendar yat' <br /> m <br /> d _ L JJ. <br /> Date of staff site visit:-l�l� Initials of site vis't staff: a 'in' <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE:7/26Q/2D21/ c co C o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 <br /> Do 0 <br /> CD a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 <br /> Burnett County, WI Land Use Application-Rev 04/2024 L . JJ <br />