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LAND USE PERMIT APPLICATION — Burnett County, WI F 2 <br /> v N <br /> Applicant Complete All Sections Below This Line 5 <br /> Permit Types and Fees:(Please,check appropriate boxes) a L Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,,D 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 r <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 4 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' <br /> 0 <br /> Filling/Grading $150 Boathouse $500 (% <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ,6,-. r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `" 1\111, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P. <br /> / off k <br /> Property Owner's Name: LaJGa (cam di rJ 4--- 1 1 K o 1vt.�i ,-)- LA,�' 1�='l in o <br /> Property Owner's Mailing Address: PG D.0 e. > C Z b ' " Lvi- G"—1 U ( N <br /> fi City State Zip -•jamI. <br /> Property Site Address: 20 €-75 ��y- paslH- l ec„..,, ,,i...,1_ ...,.„,, <br /> . o <br /> , „, <br /> Contact's Telephone Number: C+"A k 144A.C%Ce-✓ 7« ' /c / 7 3 c <br /> Contact's Email: Peiiil 5 J n Qe 11 61 2S C m a ( ( , (-6 n"� N " a' <br /> **If staff has a question about this applicaion,you will be contact via email. Make sure your email address is N b , <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov =. 00 . <br /> IP <br /> Legal Description of Property: T J`ZZ- e <br /> L CC M1. V +2-3$ 4 )7 <br /> l �d - P <br /> / <br /> Section#: (61 Town#: ,1-N Range#: 1 `C <br /> W Town of: 3 x L,[2-Q-._ F. I. N '— <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> O R <br /> Tax ID#(1-5 digit number;found on tax statement): 32 Lf �6 Q ]/ - > d <br /> Proposed Use of Structure/�nddition: � �,t (y� go or Awl b .- -I W <br /> Anticipated Start Date: f 19' <c)i) (Horn/Cabin;Commercial Business;Bedroom;Deck;etc.) ►V <br /> .1 i. ij, <br /> Building Contractor: �.L (E- Sewer Installer: 1" A • CL La-4) ' G <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> m 'Z <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: g- <br /> ,01 Nof he use. {vr Au4m ln4bi'�a �r��, 7�iis �s /_aT4 00 <br /> L) // <br /> -t Fi <br /> � IANF ou m _ <br /> �11 t / / ,f , f S S7�/ E <br /> g6mAci?.e_ TID ���� IIeCQ ct �ONd USe- ���� /� / / ' FeeRec: _° Check#: Dt-ityvo <br /> pktNNe...ct <br /> m <br /> n <br /> m <br /> Date of staff site visit: I/IO/ZT / I ' ' Is of site ff:40 _ �- <br /> lL <br /> APPROVED BY LAND SERVICES OFFICIAL: p DATE: /I7/z ZT ro co C <br /> CD c Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Ifyli <br /> CIo 0 <br /> CD SIGNED PERMIT APPLICATION IN PLAIN SIGHT L <br /> Page1of5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 tL <br />