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LAND USE PERMIT APPLICATION - Burnett County, WI c g <br /> b <br /> tn IN) <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> P <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 PD <br /> Commercial/Industrial Structure s$300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 x Addition/Alteration to Accessory Structure $150 O�U f <br /> 5 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ' pDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 5 e°.. t1. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" ' <br /> o` <br /> _^ <br /> Filling/Grading _$150 Boathouse $500 . <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> • <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. • <br /> -v <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. o I <br /> t l 0 110 <br /> Property Owner's Name: J7C✓� ..l�'f�h ?f?,f�Cr/ .e- 4vn /'cn o <br /> r� / a J <br /> Mailing 7 V�% . ��xtli r "�/ <br /> PropertyOwner's Address: O 9 L'. c mil,. r d'�r �•- Gt/s $„>'„ ��— <br /> City / State Zip 4 + <br /> Property Site Address: cSorm _ r <br /> e o N r <br /> N <br /> Contact's Telephone Number: lv w?-' 7 SO, G -C p °' ' <br /> Contact's Email: V 7J C* X,✓► 0lr7 ro J (Z S/V- ecl/r' <br /> **If staff has a question about this application,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 N ri, <br /> z. <br /> 04 <br /> Legal Description of Property: J t n rf t / n Lr� <br /> r- e, 71 4;e d , <br /> —0 i <br /> q� I\ <br /> Section#: U� Town#: go N Range#: P D W Town of: n./0,��� • <br /> l► <br /> 10 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v) <br /> G G <br /> Tax ID#(1-5 digit number; found on tax statement): N,Zg/ W FJ § d <br /> Proposed Use of Structure/Addition: go/'a-7e -� <br /> Anticipated Start Date: -/,.%,,/-V (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ? 1 <br /> x S, <br /> Building Contractor: ,,,," d;_. .//4 Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> G Meer CCU kHal4s <br /> m <br /> C <br /> 1\)04 40 lx tad 4( vunitpil vopi-6-4-1.44 tz <br /> rn <br /> Fee Rec: <br /> 2Check#: / .-,(J <br /> r <br /> -C <br /> q <br /> m <br /> Date of staff site visit: 1/7A/iligi Initials of site visit staff: 440 3 ° <br /> ffi <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE:/30 /2't!Zhi' z . i--- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF oo Cal = <br /> cD c 5e.3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT =, <br /> Page l of 5 JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />