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LAND USE PERMIT APPLICATION - Burnett County, WI c b <br /> Applicant Complete All Sections Below This Line 0 0' .. <br /> Permit Types and Fees(Please,check appropriate boxes) Z d 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 s' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 'At,. "D <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 `Addition/Alteration to Bunkhouse $150 9.)n Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 S O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 Cb <br /> Filling/Grading $150, Boathouse $500 .. D <br /> r <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. `5 <br /> ro <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. S <br /> Property Owner's Name: L 1 vi a Cam-- 1 'I ) fo t 0 o U U j)4-� . v' `tilc,jCWI pr c '� <br /> 3(0,7 0 0 S f 64 iG� (»'1cr1 'u1n k/• 7 Q <br /> Property Owner's Mailing Address: �j n <br /> ✓ rtiy_ State Zip ° `) <br /> Property Site Address: gC5--a 7� <6eiW O r-( q rYbu'r y ti1 o N <br /> i /� r/ c <br /> Contact's Telephone Number: I _ 8- 74 (p f o r a�1 _ `7"'a - 7 G r0. <br /> CD <br /> Contact's Email: \XI I it (1)q- l �v `C�)TV\ lD <br /> **If staff has a question about this application,yo will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the followingQ address: @BurnettCountyWl.gov c� �' b0 f / <br /> Legal Description of Property: ( UK(V� E <br /> Section#: ,.;7 Town#: 9/AI N Range#:'l(S W Town of: f SS �• <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cr) 0 <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement): oszs7 , 7C1 <br /> d r—e_ �, <br /> Proposed Use of Structure/Addi 'on: CL () -� �GU L. p -� <br /> Anticipated Start Date: ► (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) U \ t, ' <br /> x 1V <br /> Building Contractor: C)U..) (\ Sewer Installer: y <br /> cA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> l y d 74 e 4 y m <br /> ) �,w+ ,'� uM,�- m►�/ allow c � us �-' 30 �a s <br /> e .er ye.ar' uH /e.55 a fl'u^Imi'/ is o6f�ltnea. a+fy d y5 m <br /> v <br /> s <br /> �Fee Rec: 13 <br /> l� n be �re P,� c r/y o v o> e vn Q °-r . � <br /> z Check#;,b8,ern <br /> r <br /> -C <br /> m: c--- <br /> m rT...... <br /> J <br /> Date of staff site visit: 9/c W Z( Initials of site visi aff: /// i <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: //3I ZDZY <• 0mco <br /> U ll dUPON APPROVAL: APPLI ANT MUST POST COPY OF o o om eN., <br /> w,< N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g �rll <br /> Page l of 5 �� Jj <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />