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LAND USE PERMIT APPLICATION—Burnett County, WI g i b <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) �( <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `;, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -4) <br /> OZ Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 V\ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� 0\ N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< Vb" <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S" <br /> Filling/Grading $150 Boathouse $500 • <br /> Solar Panels(Stand alone or roof mounted) _$150 Permit Extension(1 Year Extension-Allowed Once) $100 F. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g <br /> z <br /> Property Owner's Name: "mR5 4'�� '�►j�,�1 ,4F g W ± <br /> Property Owner's Mailing Address: f IJ..5e, MA rrzo D AZ( el" • g <br /> 5' v) -C uf <br /> Property Site Address: IL gAr / D, / A9 t�Stae 4�f3 .1) o e <br /> Contact's Telephone Number: tot ' /7 a. or <br /> 'LBContact's Email: v-P Op/y`A /)U86,%�,C))V? k <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWI.gov °a <br /> r -.4) <br /> Legal Description of Property: 4 'IA) JW o FSection#: 00Town#:� N Range#: /� W Town of: v /`+" (q. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N rn <br /> Tax ID#(1-5 digit number;found on tax statement): 00 1,53 I <br /> Proposed Use of Structure/Addit on: ��� cQ/4/tiF1 l - T. y - v N <br /> Anticipated Start Date: 73 -ci (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -) vJ <br /> Building Contractor: —, _ Sewer Installer: I'V,l g <br /> '..>.1 __., <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 8 z W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i z <br /> � } -E <br /> "oo d -�f hu.ma� /1.011.W-iYA f s-1-v(a? C6Iy V <br /> l� �C -voLir1k `1c�5 40 \ Q(u dim-1'v� G lock + c, �l$/21�� FeeRec: l 1°' <br /> Q hain 6y 3 Check#:(161 /1 <br /> -e <br /> f <br /> Date of staff site visit: 12 lJ/2oz y Initi Is of site visi staff: c --J l (� <br /> APPROVED BY LAND SERVICES OFFICIA . DATE: V5/2/2-4n �+ �'u <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT v = <br /> II <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />