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LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> N N <br /> Applicant Complete All Sections Below This Line ° a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> -p-1m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 F., <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n V <br /> /Stairs/Patio( etaining Wallf dewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 l <br /> Filling/Grading $150 Boathouse $500 r F. <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. q p <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. r 3 tp <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. ° ' <br /> Property Owner's Name: .PI,Nikt e, ow(ca C S Lk•/Ir! a L S f �'u`s-V o N tV <br /> � <br /> Property Owner's Mailing Address: ti---12—b c( f' tJ "2u:S.,,Mon, WI:- SNdrt 77. n <br /> C It ate Zip <br /> Property Site Address: ��� fA 1 yQS 1 �n c.fy Cl3 5 ��� C — <br /> o <br /> N <br /> CD <br /> Contact's Telephone Number:"`j 1 —ZZ©- S Tcl hl <br /> d i <br /> Contact's Email: ?r,,it i ,1, 4 tE,. 5 Qci W1c.).-1 k.Gt dl'v .. Ilk <br /> **If staff has a question about this application,you will W contacted via email. Make sure your email address is N ro -C <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov ° 00 o0 <br /> Se IV <br /> Legal Description of Property: 1..r7r Z. L-Sw►Sig-f`i 'to I 1.9 V)2-7i c` 5C.4'( f&Dv Lott ° N cv <br /> Section#: 5106 T`-Town#: {O N Range#: V.r5j W Town of: - Lso.� 5* <br /> L. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C/' <br /> 71 1- <br /> r <br /> Tax ID#(1-5 digit number;found on tax statement): 22(P OA 5 <br /> Proposed Use of Structure/'tiddition: 13c+0,,.n..A. Lfri - V <br /> �\ � CA <br /> Anticipated Start Date: NA-- ex f( 7 , Z3 (H re/Cahin;C n/� CI <br /> rn ci Business;Bedroom;Deck;etc.) �[ <br /> �� � f x <br /> i- w <br /> Building Contractor: u'a*? �--�.. Co c��,4tAzN'See r Insta er: ) 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: dri <br /> 0 M fe-1.- c %Pi9a 3 77 <br /> a42 <br /> T, Fee Rec:asb p <br /> ° Check#: p <br /> r <br /> z <br /> m <br /> n <br /> m �— �J <br /> C7 m - r <br /> Date of staff site visit: (/24'--y Initials of site visit staff: (L Q U <br /> APPROVED BY LAND SERVICES OFFICIAL. ����(%, C�DATE: 1/10/2021/ c.3 <br /> m <br /> till <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a a Q <br /> v = ,s <br /> Lu,< N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT B <br /> Page l of 5 (L i <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />