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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 Z. <br /> 0 4. <br /> Permit Types and FeestPlease,check appropriate boxes) a' v 1 <br /> O <br /> Dwelling/Principal Structure $300 ,Addition/Alteration to Dwelling/Principal Structure $200 v ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> A Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4 <br /> cc <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <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. 4 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> o II,. <br /> Property Owner's Name: /..D r-o .,r am.'n SS'- r o --ta o W <br /> % Le <br /> Property Owner's MailingAddress: S 1-4 /V 4-�� (H a MAI ST�`iL w. i <br /> pity yZ9 /n!9R. 6lvc-jn <br /> City State Zip ° c) <br /> Property Site Address: 2-e S S_,- (3 t 2 c..1 S 4-001t) 4,p ik i. ›/Z_ a, byr�y ( S YJ'3 c, < <br /> o y <br /> Contact's Telephone Number: '' 6 ° 68 1 7 I 4 '2.- a <br /> 1 I?Contact's Email: aY�r-o .-..5-'1,3 Z. (:=_--j 1,-,--s-, / . co-,"- =% <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: @BurnettCountyWI.gov °ogo <br /> °O N <br /> Legal Description of Property: S to15 c,-/-B.- y Es- .'Ye S 0 AI 3,1 rt L is)6 1. )(es_ La 1 Q d <br /> Section#: 0-1 Town#: LID N Range#: 1� W Town of: S G o t-�- .' (>o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*/ 7e� v) <br /> 2 _ v o <br /> Tax ID#(1-5 digit number; found on tax statement): ?2 3 R ' 9 a <br /> d <br /> Proposed Use of Structure/Ad itio : G_"c\v-'k-y -e— , 0 -fl <br /> Anticipated Start Date: `/ /5- •Z.,-( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> • <br /> Building Contractor:/"o I K.1 /mot(e t✓r 5- I.1 c. Sewer Installer: i7G <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c: z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z po <br /> 0 -et4' au 52uc. S <br /> CV- -01o.e. U�.Sed -�,r env.-ni& yla bi- br1 <br /> © wi C. --1/.1_4 `l A bk Se.c..u.re i, U�' ' ` et 1 OC.k C✓lci C ii i V1 19\( I0II5/ z[ ..,1 Fee Rec: 'l5-0 <br /> °z Check#: 111'4 2 <br /> r <br /> DOec)c re?lacLnne fl- -I'►mfrOvtrik rl+ r\tecJ tZ Lund Use ft iiml'+ by to//skt <br /> m <br /> / v <br /> Date of staff site visit: �/ZZ( ��{ Init' Is of site visit staff: ��-+ 1-r > - [ITt] <br /> q n uuU <br /> APPROVED BY LAND SERVICES OFFICIA : DATE: //3 2-4Z m W = 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o N IJ <br /> � = o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> ffli <br /> Page 1 of 5 = ` <br /> Burnett County, WI Land Use Application—Rev 04/2024 �' JJ <br />