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LAND USE PERMIT APPLICATION —Burnett County, WI• a 0. <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> a. <br /> Permit Types and Fees(P/ease,check appropriate boxes), C7 <br /> Dwelling/Principal Structure 4$300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 U'\ i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e I3 I\ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 k <br /> Filling/Grading '$150 Boathouse $500 1, <br /> � <br /> Solar Panels(Stand alone or roof mounted) $150_ eermit Extension(1 Year Extension-Allowed Once) $100 k <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. b " <br /> o k <br /> Property Owner's Name: Y ii- 7'S o <br /> a <br /> Property Owner's Mailing Address: (,; i C3 Cc;�Ad r 26 X /EAS"l�z &/ ✓ eQ� a. N <br /> City State Zip <br /> Property Site Address: -4,t' o <br /> Contact's Telephone Number: (, ( - 2 8 U `au,6 n' <br /> Contact's Email: S i4r p7'-YSo ' (`? G( 6Y#/4- , co X-/ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .c <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0 °O <br /> cro <br /> Legal Description of Property: al %t?C r S N LO L `f C- S d2 Cr S' X d <br /> E. <br /> Section#: S 13 Town#:I ? N Range#:1 I ' W Town of: G G N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* En <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): // ip 5 � d <br /> Proposed Use of Structure/Addition: -r CIT A ri,Aa--- H <br /> Anticipated Start Date:P 1 E 0 r 7 E L/1/41/ / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z <br /> Building Contractor: O ,v�f' Sewer Installer: <br /> u, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rn <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> (��hks verrri,-�- -Isavt tx-�onsi�A LI,�P- 23 - 51s`1 and �,.i�( < F <br /> 'ex,piq $ )lSI202'DFee Rec: /00 wrv40 -fvr l z Check#:(15it <br /> 0-lar shtds - y 1 r <br /> P lae ik r nv��e..d o� Y evnDved b g�l s 2 o2S � , mi l J <br /> Date of staff site visit: Vel/ZaZi4 Initials of site visit staff: t' kiT "' Q <br /> p 3m = 0 <br /> APPROVED BY LAND SERVICES OFFICIALfWiTi h re& DATE:Q //5/2L / 0 CD <br /> Ii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 ,�,I <br /> N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a ITV <br /> a <br /> Pagelof5 l JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />