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LAND USE PERMIT APPLICATION — Burnett County, WI c 0 <br /> 6 PI <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Feese/ease,check appropriate boxes), a. <br /> C7 <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 .1 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 /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 cA <br /> 11, <br /> Solar Panels(Stand alone or roof mounted) _$150 Permit Extension(1 Year Extension-Allowed Once) $100 _ 114 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> '-v <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> o <br /> Property Owner's Name: 1 {� 5- N <br /> Property Owner's Mailing$Lddress: 7- l ) (� I' v'e' NW C r /CW1I` ! u " `C� p <br /> ` <br /> ZZ y <br /> ''� 0 � C ^, , WTtYS State Zip <br /> Property Site Address I' 1�t tal 1(it-t o 'I, <br /> co <br /> Contact's Telephone NumberTg3 213 fl e>3 °' <br /> ,Contact's Email: Q�y'1 Lt r....d.,,,,,,,, CD <br /> **If staff has a question about this applicationwill be contacted via email. Make sure your email address is N 61 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov a 046-4 <br /> ao <br /> Legal Description of Property: F l 1 y L' K z - ZI o <br /> Section#: 13 Town#: (b N Range#: 1.0 W Town of: CJ c C0/) �' I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* in <br /> Tax ID#(1-5 digit number; found on tax statement): �2_1 <br /> q t 0 <br /> C <br /> Proposed Use of Structure/Addition: Wd11441.609 1 RV eet,i /sl- t .i C-( N� <br /> Anticipated Start Date: K Home/Cabin;Commercia Business;;Bedroom;Deck;etc.) <br /> Building Contractor: Cv�3 cs,Y" ? .,t.tl j,., ., Sewer Installer: k�,1 Q\-- C 3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z x <br /> v <br /> CD1 'MR,-" Caik 5t+100‘c k-S \n <br /> Noa �e use 4� 1nu�,rtc> i-E-u+ �''-' Fs® <br /> Ct <br /> I ��w, �^ Bey, <br /> 3 CO ,,,,, L d nut 4-1'Vlt 3D days Ill a (a te( yet Fee Rec: /5 G` <br /> " {n D{ z Check#:-5 ,5p1 <br /> In-AA AO tt" 0, (cuyyinei p-ren s - <br /> ((I Drmi4.d kr at.Q-22-3D2 ha tktioiv?d tAd w&S YO L+ <br /> tUiri� � {��� <br /> �j v 0 <br /> Date of staff site visit: O /Z1/� Initials of site visit staff: 6L'`�iT C Q- <br /> �/ g <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: (7��4/ / `-.B G.)o co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT B [ttr <br /> Page 1of5 L - JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />