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LAND USE PERMIT APPLICATION —Burnett County,WI <br /> Applicant Complete All'Sections Below This Line p' y �`' <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> a i'. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V,...D <br /> yAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> i : ._., <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I <br /> n <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 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r <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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z �' <br /> Property Owner's Name: U,l t ! h i Q ir. Ta1 be.ei-c,, ii IN <br /> W Property Owner's Mailing Address: Li 350 S W c'lS o 1A '2 � <br /> C1 lye ba r g 013 b <br /> City .State Zip O <br /> Property Site Address:4::? y 3 5 0 -U ti.A5 0 rR1J W.�1) .{',S IA) 1 y e Q _ c <br /> Contact's Telephone Number: 16 - S to a t y '''0 C cut- ) I~ <br /> Contact's Email: b e €4CAR c op `' le-1 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> V N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov <br /> Legal Description of Property: IRj W IV' i i✓4 iV 3� i <br /> i9�i' c k- w �-1 y rJ 1 x C V � IoAC. d by <br /> Section#: I 1 Town#: 3 N Range#: i W Town of: ` u Y1 i Q,N f. N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CD <br /> = I1 p <br /> Tax ID#(1-5 digit number;found on tax statement): • 0 p 09 e <br /> Proposed Use of Structure/ dditio : iS' it Ci C • <br /> Anticipated Start Date: " 0I— g 14 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> y <br /> '5 .I <br /> Building Contractor: \`V- Sewer Installer: -i1 1 W — <br /> g. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Ni <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: :. "4 <br /> 0 <br /> D AAR e,} a�l fie,-l4ba J <br /> ri <br /> DI <br /> NodAD -Ut4 f� l' ill' <br /> h r liNdl Ul <br /> Co <br /> Fee Rec: 15 <br /> z_ Check#:h / <br /> , k <br /> Date of staff site visit: I'S Z02y Initials of site visit staff: cn <br /> q <br /> APPROVED BY LAND SERVICES OFFICIAL: nit Tr: 2 . <br /> UPON APPROVAL: APPLICANT MUST POST COPYOF j o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 JJ <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />