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<br /> LAND USE PERMIT APPLICATION—Burnett County, WI a
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<br /> Applicant Complete All Sections Below This Line 5 m
<br /> Permit Types and Fees Please,check appropriate boxes) 1 d t j
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,`
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I
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<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I
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<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I
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<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 I .<
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350
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<br /> Filling/Grading $150 Boathouse $500 Ir0cr.
<br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100
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<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.
<br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -.
<br /> Property Owner's Name: p,,,/ 5- B r'r,t ,i,,, , lZ bcv'F r-B r.-,,I-e✓ 0 a M c. !�_6 r7� e-I-1t)
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<br /> Property Owner's Mailing Address: /f y5 Ac /}•i ✓o {fi rn1 5'..' i1 ,t1 'V5 F.. n
<br /> City State Zip I 1
<br /> Property Site Address: 1174 '-1 I-,ke 7 a" 2,,,.•1
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<br /> Contact's Telephone Number: h y/ S I,0 I q't,s e'
<br /> Contact's Email: rI;r,i .1(.-r ..; C' 4,,-,., I c _ T e i 5 f t9 ri firOf , Lar
<br /> **1f 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: @BurnettCountyWI.gov 0 I
<br /> Leal Description of Property: f Z L 1..�,N. Si2t 2 ' I / Za8•`O2e
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<br /> Section#: 2 2 Town#: 'f/ N Range#: is W Town of S.v i s� g.
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* >0m
<br /> Tax ID#(1-5 digit number;found on tax statement): o/I D 35
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<br /> Proposed Use of Structure/Addition: /,.,h,4 b a,'"`, ,,,, ,-, t l/a 4 -i
<br /> Anticipated Start Date: •/uiG Zy (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) (�\
<br /> Building Contractor: k:al c;.. Sewer Installer: „�;t,„.", I ;�
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Z V,1
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z (V\ VN
<br /> 0 Sc1h �a,p SLtmt,�5 S/ /$ oti� otc74-4 e �oo404/�'1•
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<br /> 40 /VOt /D ICI 3 0 elI'b DI S 9c . /(W--e 51�-/7Z—0 Fee Rec:, �F�
<br /> z Check#: 1`7
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<br /> Date of staff site visit: �P/S�ZI�Z� In. ' is o •to v' ' ff: y W ff
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<br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7-6'2. u W
<br /> UPON APPROVAL: APP CANT MUST POST COPY OF 2, ff
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<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT
<br /> Page I of 5
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<br /> Burnett County, WI Land Use Application—Rev 04/2024 L� J
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