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LAND USE PERMIT APPLICATION — Burnett County, WI cr <br /> cPI <br /> ro <br /> Applicant Complete All Sections Below This Line ° c <br /> PP P a I <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 DO O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 v <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 16 <br /> Driveways/&Campground Structures r"$125 WI State Statute 59.692(ly)Structures $350 0 * <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 = <br /> m <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> 2 III <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 9' <br /> Property Owner's Name: (6viold O tO 0 F. p <br /> � j� mil a <br /> ��� I <br /> Property Owner's Mailing Address: ' r`q tilt Rt Ceyrkw0e / ` 3 I n <br /> City State Zip <br /> Property Site Address: LaV e3t?4 4o 6317 lia ydot* Wq)/ kIY toss c <br /> Contact's Telephone Number: .76 3- rQ f i S • <br /> a <br /> d <br /> Contact's Email: (V Y\ e rut met " C. o w/ ° <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: BurnettCountyWl.gov B. °Q <br /> 3 a m 504 5 V l en F9,2 7 Re cordent it, <br /> �yLe 1/� seri�p?tion gqfPr erty: �_ yy,C✓1f �l7[sol l 7 LtsL b cZ L. *k �Srr71� ° <br /> rt `�7OY LOtn. <br /> Section#: 1$ Io #: Li i N Range i?: 16 W Town of: S Lai SS <br /> *Attach additional page if needed,for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 3 5s c 3 N <br /> e <br /> Proposed Use of Structure/Addition: hd e —3 <br /> Anticipated Start Date: �/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (� <br /> ,p N <br /> Building Contractor: e�f Sewer Installer: N/14 x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMS/CONDITIONS ONLY rn <br /> KNT z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> C <br /> cn <br /> FS <br /> a, <br /> —Nei da b& osa totiital luoird-.rob <br /> �/SL1,2' 514AcQ 4P �jL *toyed � 610- OHUM, 5aa, IV/ Zo2z( o Fee Rec: 1 vt''� <br /> 0 l z Check#: 242R- <br /> -C <br /> rt <br /> Date of staff site visit: 7/1A/1 M( Initials of site visit staff: (- kz � <br /> I. <br /> = 0 <br /> r- <br /> t <br /> APPROVED BY LAND SERVICES OFFICIAL: j14'dZtt2) DATE:p M!Z0Z1-( <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF U <br /> cc <br /> 4 V <br /> w N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT INIJ <br /> Page 1 of 5 J <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />