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LAND USE PERMIT APPLICATION — Burnett County, WI a i <br /> b <br /> Applicant Complete All Sections Below This Line CD N <br /> Permit Types and Fees(P/ease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> O <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 /> C) <br /> VDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °a° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r _ <br /> 0 <br /> Filling/Grading •$150 Boathouse $500 Q, <br /> co <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. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. a vk <br /> `,y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a • , <br /> z <br /> 0 <br /> Property Owner's Name: L) V(d k_r ay, b Sew,.k r t d =' -C ' <br /> °o <br /> Property Owner's Mailing Address: S-1D 414n 1^-Kb L< 2S M ki S 5 (Ili w <br /> n City State Zip 0 �' <br /> Property Site Address: '351 1 S' e.44+v ct4 - 12-I. < i <br /> o• c <br /> Contact's Telephone Number: (0(Z il-qO 1.--s3 0. a <br /> Contact's Email: oO d. roll e 0,w,,, i i wN t**If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BuurnnettCountyWl.gov 0 IQ _J �v <br /> Legal Description of Property: (.J"f' L{' CS All1 ? b i i^ l�°u Lot I b CD 1 <br /> Section#: 3 b Town#: -{o N Range#: �S W Town of: `J S L. k S a,n N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> Tax ID#(1-5 digit number;found on tax statement): 6( I3 o <br /> Proposed Use of Structure/Addition: (cb; n -i <br /> Anticipated Start Date: Q/2° /'V 2y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> 13 .0 W <br /> Building Contractor: Sewer Installer: h o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v z <br /> 0 Fo l tow ck -Q- c -i1)(t5 154- \)cx c (e , V - 21 -2D 0 <br /> @)TWA- S\ADVA-C Of\ Cv,l;rin Ro-�- al-o d ko ` ( w <br /> Fee Rec:4 125 <br /> bX 4)(Ad Yt S'u- e \-1- .IS VLO-4 CDnnec,-fed -11) - t Sane-t)JY`I StiSa-e.✓n z Check#: 468l <br /> x <br /> m <br /> n <br /> m <br /> "" o �J <br /> Date of staff site visit:7//(Q120Zq Initials of site visit staff: TT -3 Q ni CO T1 1� <br /> APPROVED BY LAND SERVICES OFFICIAL DATE:CM(1/ZU� co W = 0 <br /> 0 CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Erin_ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 ��l <br />