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LAND USE PERMIT APPLICATION —Burnett County, WIF. `° r <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and Fees(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C ix) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i9 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G] r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r x <br /> Filling/Grading $150 Boathouse $500 <br /> CA <br /> E. <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. I*Items not listed above will be treated as accessory structures,such as:pergolas,// landscaping,etc. o 11 <br /> �y <br /> Property Owner's Name: A�/�/ r e 4---- 14 E�S`l 11 A &/ Q ( " <br /> o <br /> Property Owner's Mailing Address: 0W000 I<4;� Ott °-9 /�/ Si vital AA,'�-/fS , <br /> p � y6,, <br /> City State Zip 0 <br /> Property Site Address: 3i 3 2 K r L s-r- p,Mk Ro o e ' <br /> • <br /> Contact's Telephone Number: 6l a— 3? S= 6 .9- 6. 2 .. <br /> v <br /> Contact's Email: dAI.J bC (r- T R.ftchlo Vkt403. toi,-\ <br /> **If staff has a question 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: @BurnettCountyWI.govg. <br /> Legal Description of Property: ,S/ R / '4 0 N R t `4 W (0 `U f-O T 3 o <br /> / 'Y/ r N <br /> Section#: [ q Town#: 0 N Range#: f 1 W Town of: SC-0 r <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CA <br /> 0 fr o <br /> Tax Ti)#(1-5 digit number; found on tax statement): j $Z 0 <br /> � ^ nC7 <br /> Proposed Use of Structure/Addition: G I t"�4 G-C i rt g T/ Rc, ,"i I -� S �n <br /> Anticipated Start Date: lS "ell (Home/CaHfn; ommercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: D W N Sewer Installer: p Kt/ 5' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY tri z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> nYlke4 Cli) R.-149aGkS ,,, <br /> rz <br /> 0 Nod -b 19t. BSc d --FDK hu,mu,' ket,b1.4dr.O1 no <br /> L (gyp-��� L(ZIS) .,,T <br /> Fee Rec: fb( <br /> �p��pW Y►/IITI�Gt-1 -I z Check#:_6 <br /> r- <br /> .t <br /> m <br /> n <br /> rxi <br /> tri <br /> o <br /> rr II ��n� <br /> Date of staff site visit: lal tZ1 z� Ini ials of site visit staff: LrY// �' 0)l� a - t u <br /> ��^^ m c <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE:7 29 !� <. <br /> c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF .0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 0 .Inftl <br /> Page 1 of 5 L. J <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />