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LAND USE PERMIT APPLICATION - Burnett County• , WI a r <br /> Applicant Complete All Sections Below This Line 0 m .. <br /> N 1 <br /> Permit Types and Fees(Please,check appropriate boxes) o. <br /> C7 <br /> Dwelling/Principal Structure _$300 Addition/Alteration to Dwelling/Principal Structure $200 °; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r N F <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150Lii <br /> (, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e° <br /> lV <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 016 <br /> Filling/Grading $150 Boathouse $500 <br /> r ty% <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `5- <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. <br /> o lb <br /> lbProperty Owner's Name: q c r I� k 6 iv1/4-d r< nd o <br /> Property Owner's Mailing Address: <br /> S j 6" a o/c( 35— R j PcNh"r-� j"rr3o lic. II <br /> City State Zip ° <br /> Property Site Address: 1- *w L� Z . <br /> Contact's Telephone Number: S b 3 , S‘2 0 (P Y a <br /> 1 c( <br /> Contact's Email: I_t'. r�j.,,�,[�) �( ,2-� 7 (iVAlk t, [.CoL y <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 0 00 <br /> 5" <br /> cm <br /> Legal Description of Property: $ot, p <br /> Section#: OS Town#: lif N Range#: 1r, W Town of: S w1 S S . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C, o H <br /> Tax ID#(1-5 digit number; found on tax statement): i I �'� w l� <br /> C <br /> Proposed Use of Structure/Addition: C "� 1 0 r I-}� .� E N <br /> Anticipated Start Date: CJ .f 1 I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: N N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r°n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z po <br /> 0 No--- —0 be (Ad Ai liturnaii fri.c021-1-rk-ii.ry-1 „, <br /> . <br /> < 0 <br /> m <br /> C Ca(et(-1- M oe 10-4- ---o -c-'L tas+ -I��ardS `� <br /> U <br /> D'L M Fee Rec: `� <br /> C�1('i, '�0 Vtij- v - k 16c-1- s +k1 40 Cr}`' z Check#: ' <br /> b,.ir Si-1-t ViSi+ DA 1I3t1ZC - Cal"Po(1- -fit) Ivc- rvOhre.cl12LI <br /> 8I1I2°26• <br /> J <br /> �'"^141 <br /> v w <br /> Date of staff site visit: le zaq 41 I31 /10V I Initials of site visit staff: K-+ &iL a t— <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: I _ ` C ��nj <br /> 6l1 U' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 ~' <br /> � � C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 +- Itln1 <br /> Page l of 5 LL JJ <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />