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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line �' CD I <br /> Permit Types and Fees'P/ease,check appropriate boxes)j a <br /> C7 <br /> Dwelling/Principal Structure $300' ,ddition/Alteration to Dwelling/Principal Structure $200 E 23 <br /> .mmercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> •;)",ii:Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' • <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <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. a <br /> / I ' 1 0 <br /> Property Owner's Name: J fir lr Ar - jam€y �C. 1/C(�E'•h ." v <br /> d p ,,�/� h rye,! 0 q <br /> Property Owner's Mailing Address: ‘24Z Z eg_eai 1 5 ��� J 1 iri e ' ,/ i s ' , <br /> 231/6 old 0 3� Si reti State <br /> I e 51872 City <_ i N 11 <br /> Property Site Address: (,� <br /> / .!i <br /> Contact's Telephone Number: �O Z q6 S - 7 S 7 % <br /> Contact's Email: ! tine ) �'D <br /> **If staff has a question about this plica ' n,you will be contacted via email. Make sure your email' ad address is , r, ti <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov o° °Q <br /> Legal Description of Property: 4 4 ✓' <br /> �1� .. �� OS/r Y f�5/ d ^ <br /> rA v <br /> Section#: II, Town#: 3pp N Range#: 17 W Town of: if, <br /> 5. 11II <br /> •*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f� c4 <br /> Tax ID#(1-5 digit number; found on tax statement): aaa_ , F 5 <br /> 5 <br /> Proposed Use of Structure/Addition: 11111110 ar -4'season rdi r ` en H N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 2orGn f N <br /> Building Contractor: Sewer Installer: y N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> y <br /> —M t to &,U k rtev..u>c ncivk's tr J <br /> �- DI,st ,ZA5 v At 41-cceit i ballrooms Re Silly— oG9 m <br /> . <br /> CovvieArj- UpL "VD Ccclsliurc. V1eUSSQ4"7 ea" ¢S 9 Fee Rec:.2o0LP1 <br /> �dG Llynti 61 4 l pj`may{ z Check#: l 4 2_0 <br /> —Po 'tD 1 SedWa(k-, (� / / /� f P� �r f— Z.(.t l��- Z/-o 2_ <br /> -- J�'1ad`ag2 U`W/ t`L S J�`c1�- '7Y�►n� <br /> , ,l 6 /i/2ozSo m <br /> b� ►�50 (� /_ ° w DR <br /> Date of staff site visit: 4 i-2 ZbZ`� Initials of site ' it staff: V 1-- a �- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: OA-172Y' Z.3 <br /> 2 `-° w uuu'nn' <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF o= N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3ITH <br /> Pagelof5 L— „Jj <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />