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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 0 c 4. <br /> Permit Types and Fees:(P/ease,check appropriate boxes) ! zn. l.T <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 (T\ p <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ; <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 r <br /> Filling/Grading $150 Boathouse $500 <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. & <br /> -ci <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 /> z <br /> 4 o <br /> �,Property Owner's Name: 1/MS H. PECK\ �- <br /> C�R�L ��CK n <br /> /l nn �/ �/ I- , D2� 00 <br /> Property Owner's Mailing Address: ,2g950 K,I L KARE 0 I• !U1( CN/�IO.JV w n <br /> C� n t City State Zip ° 4 <br /> Property Site Address: c2B 50 KIL(<A(''' D. < <br /> o r <br /> Contact's Telephone Number: -7l5 -2Sg-3928 a <br /> d <br /> Contact's Email:J(A1 CA kOL Pee Ka iota.t I. CO,V <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 °Q <br /> 5" <br /> ao <br /> Legal Description of Property: W Li I,, OFS 5Q8 r /VE SE. p <br /> Section#:07 Town#: L-(a N Range#: /q W Town of: SCOT" o <br /> =. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> l— 0. o <br /> Tax ID#(1-5 digit number; found on tax statement): 1775L1 ,J g <br /> Proposed Use of Structure/Addition:I V 1-(!C L E 4 EQU f PEP IT ,S'r0(''A GE H (� J <br /> Anticipated Start Date:Ct II- 23 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) S <br /> Building Contractor: TANSSEN; L.,LC .4- Sf2 F Sewer Installer: NON . y c" <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> —Aiteft x.( 50 - vseipt&044a4t5 rl <br /> ro <br /> cA <br /> Fee Rec: QUO <br /> 0 Check#:gz 5 I <br /> z <br /> r <br /> P <br /> m <br /> v C J <br /> CA r <br /> Date of staff site visit:b/i"1/WV"( Initials of site visit staff: 6 L ��� XI› g <br /> n <br /> ��/ <br /> APPROVED BY LAND SERVICES OFFICIAL: �it �z,�ri�wti/ DATE: 87151207if °T 0 <br /> Ira <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 a 4::,0 o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> Pagelof5 m Burnett County,WI Land Use Application—Rev 04/2024 1 fr <br /> J <br />