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LAND USE PERMIT APPLICATION—Burnett County, WIcr <br /> ro <br /> 1.4 <br /> Applicant Complete All Sections Below This Line 5 044. <br /> Permit Types and Fees4Please,check appropriate boxes) P pyn <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `J <br /> Commercial/Industrial Structur- $300 Addition/Alteration to Commercial/Industrial Structure $200 ..D <br /> O <br /> Accessory Structure(Garag:,Shed,e c.) $1504 <br /> Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Comme ia/Industrial) $200 Addition/Alteration to Bunkhouse $150 CD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 vi r <br /> TO <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> >i I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b II <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o 0 <br /> Property Owner's Name: t.r M '3ryi1 r i I e- " <br /> Property Owner's Mailing Address: ZZ CO 114?li Pr AA, ;et i 014) SAS n n < 1 <br /> City State Zip ° `R Q <br /> Property Site Address: Z �C\ 6- y.�ll�..� gi✓.�r (iv �•.. ,City <br /> 111 ( 41c3C) < <br /> Contact's Telephone Number: if SZ 75 -?S .. <br /> Contact's Email: j>r i d 1 _ L� b <br /> **lf staff has a question about thisIp C.plication,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider willaccept emailsls from the following address:@BumettCountyWl.gov . <br /> Legal Description of Property: /Arci4m S f'-i v/"r (I' S Lv''� 3 q d <br /> Section#: 0"4- Town#: N 0 N Range#: I C. W Town of: OA,kIG.,.,si <br /> *Attach additional page ijneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> a C <br /> Tax ID#(1-5 digit number;found on tax statement):j I H Z 4 G W J 1 <br /> Proposed Use of Structure/ ddi 'on: f1 •-' <br /> Anticipated Start Date: . �' (Home/Cabin;Commercial Business;Bedroom Deck;;etc.) <br /> Building Contractor: /0- -Se � Sewer Installer: /12 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> n <br /> 1 �l y <br /> N0� 40 � Y � Fee Rec$/6 O <br /> z° Check#:5O/ <br /> r <br /> rn <br /> n <br /> M <br /> VIL/ r <br /> Date of staff site visit: � Initials of site visit staff: (L+�T13) <br /> APPROVED BY LAND SERVICES OFFICIAE ,(`t-161t/ DATE: VS/M2/ cC0 i <br /> 5.3 C:) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD o � <br /> -- <br /> po Cal Jury <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N C, <br /> Page l of 5 ? M <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />