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I A p proved PP,erk <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o c <br /> Permit Types and FeesPlease,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n G <br /> Th/ Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> '` Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures _$350 r <br /> kl <br /> Filling/Grading $150 Boathouse $500 0 ~ <br /> En <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z. .- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '5 <br /> ro <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. F <br /> Property Owner's Name: '� ) $ A11 vt Ate- 1^ o ...- Lk3 -6 <br /> 0 <br /> Property Owner's Mailing Address: r F0 ,f 5 c-'el J' 'li 01\ Vasil oer wa-- 5-9 7C °' n <br /> City State Zip ° E il <br /> Property Site Address:�.5257lv/ 5 w_-y-e,r r4 pav0.0 L,\� Y u-a- S Li E3l) 0 E2 <br /> Contact's Telephone Number: 7/5 --E66 5O27 4 L , .21 733-05 07 C ' I 1 a <br /> d <br /> Contact's Email: r'y)00-e f S'q F36) Q Ya L.oo i r e.i r-` - '' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro - P <br /> legible and your email provider will accept emails from the followinglo address: @BurnettCountyWl.gov 0 T.)g p p rty:Z OT I Cs i— V `T c 2 7 2dLe al Descri tion of Pro e <br /> Section#:O 7 Town#: 616 N Range#: f 5 W Town of: C;r SC <br /> J <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v) <br /> Tax ID#(1-5 digit number;found on tax statement): 5/ L'i5 <br /> -0 <br /> o <br /> `� <br /> `n d <br /> Proposed Use of Structure/Addition:t�ecr T;etni r a��-,,'- PST 10 w ,T i c-e- V,v-i <br /> Anticipated Start Date: 'e$ M T Appro 0 ed (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) S <br /> Building Contractor: hp %,'k>.c Sewer Installer: = Q C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: opo <br /> 0Merl- a1k--N S <br /> U) <br /> m <br /> v <br /> Fee Rec:AZ-' <br /> ° Check#: 5 4' ' <br /> z <br /> r <br /> -C <br /> X <br /> R <br /> m <br /> o <br /> �] 3 Initials of site visit staff^-f� t� r- <br /> Date of staff site visit: i ZoZy = <br /> a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Ri I 12ozzi w <br /> 5.5 r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m ~ N iiiril <br /> 0 cry <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N CIC <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 "C..----.)) <br />