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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' w <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 tin o <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �1 r 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C'" .---\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °<_ G <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> 0 <br /> Filling/Grading $150 Boathouse $500 v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ErI <br /> w 0 <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. r1. V <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: -1-6WyN. of Oc _1c ', - to a a % <br /> Property Owner's Mailing Address: 'Q t). 3Ajk 1a15 wt.Iv s 4C W 1 94 VI 3 n II <br /> City State Zip 4 <br /> Property Site Address: 20p 5S 8 Fre,y1 die. 00'.1.,:bu‘, Ni.11 S3 8 3 v o y <br /> �J a <br /> Contact's Telephone Number: 1 1 — SZ_0�" a4 I °- <br /> 135 1`\ � <br /> Contact's Email: c VI 09-iv OOI.1L� • w 1 .90 v <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov ' 0Q <br /> a. <br /> Legal Description of Property: N W SZ E' 2`( (2T OF- w 1"/ d <br /> S. <br /> 1 <br /> Section#: l� Town#: Lft N Range#: 9..\kg W Town of: 0 ak-'`c"hGk r) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* u' <br /> _. o w <br /> IN kTax ID#(1-5 digit number;found on tax statement): 133 i�TpC <br /> Proposed Use of Structure/Add'tiot} S ( l�'Dl C r►G✓ g W g '- H <br /> Anticipated Start Date: 01111 ' .o v.+ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,- <br /> Building Contractor: Nil er Sewer Installer: 1 A d W <br /> AREA BEL)W THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r z <br /> 0 N.) <br /> THIS PERMIT IS SUBJECT TO/ALL CONDITIONS LISTED BELOW: o <br /> /V©t 7° ie- LAe l -fir !1 u rA 4 h �1 a lo/Ta 7`7o�J, <br /> m <br /> Fee Rec: AM- <br /> R Check#: <br /> r <br /> -C <br /> a <br /> m <br /> cz <br /> m <br /> m <br /> ?I <br /> n o c l <br /> Date of staff site visit: I/'VW Z y Initials of ite 'cittaff: Q/� . �r <br /> QQQ ro <br /> APPROVED BY LAND SERVICES OFFICIAL:4 ���" - DATE: 9/20//O0 ie W �t� 1111.1 <br /> 7 z 3 -u 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 17 a ., l <br /> fni <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT II <br /> r <br /> ra3 < <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 "' , , <br />