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• <br /> LAND USE PERMIT APPLICATION -Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> CD I <br /> a gs <br /> Permit Types and FeesfPlease,check appropriate boxes) o <br /> Dwelling/Principal Structure $300_ Addition/Alteration to Dwelling/Principal Structure $200 a\w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °, N b. <br /> IN Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 • <br /> • <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 i <br /> p <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '� „A <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. A <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. F. <br /> o <br /> Property Owner's Name: fi er " •-fq r a 4 rdi" ! ` _ / F.0 N <br /> Property Owner's Mailing Address: 3 O ,3 D /�n w y �� AV s J 67 b ? c� <br /> / ° -� <br /> / p City State Zip <br /> Property Site Address: 6343 8//C c 5e,�1 A.t /v e I f re IN I^' ,'r`��'13 o N <br /> �.f'/ � ‘b / 3 6 0 _a <br /> Contact's Telephone Number: — <br /> / -0 o <br /> Contact's Email: SIC Y c.S 4 ✓`Q./r G 1 i R/j1c i n S v J' •c,n e c • C o ." <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,ti <br /> NI <br /> legible and your email provider will accept emails from the following address:y @BurnettCountyWl.gov 0. tuo <br /> 0Q <br /> Legal Description of Property: 0 7- 0(60- i. -3 /-/6- 2 `- / 0 2, - o o to o 2 2 0 0 0 p. ~ <br /> a N <br /> L // � U1 N <br /> Section#: b Town#: 3 9 N Range#: / b W Town of: /�'I e c e/ o r1 8 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> VJ N o G <br /> Tax ID#(1-5 digit number;found on tax statement): I 102.1 -c. <br /> 0 <br /> Proposed Use of Structure/Ad ition: J'T-t , e s 7- 4 el 0(--tl .-3Anticipated Start Date: Co et C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) QN <br /> Building Contractor: °IA, Sewer Installer: c7 -9 -.0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: › x <br /> D S Fug rS no-v- -{U -ex-c e.e.A 5 - Int <br /> C <br /> n <br /> m <br /> v, <br /> h _ <br /> Fee Rec: lay(.19 <br /> z Check#: 5/i <br /> r <br /> r, <br /> to <br /> rri <br /> to <br /> cn <br /> t J <br /> Date of staff site visit: <br /> S I 26p /201..!! Initials of site visit staff: ( -3 w <br /> rfirg <br /> APPROVED BY LAND SERVICES OFFICIAL DATE:Ve7/2t2� b W W 'A 0 <br /> < o ') <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o u, I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> inni <br /> Page 1 of 5 CD <br /> Burnett County, WI Land Use Application—Rev 04/2024 �L JJ <br />