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• LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> a. <br /> Applicant Complete All Sections Below This Line 0' 0 4. <br /> Permit Types and Fees(Please,check appropriate boxes) a' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 rS'1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,D 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 /> 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 <br /> iw <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. `5 km—A <br /> r <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ° 1 <br /> 11 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g . <br /> z <br /> 0 <br /> Property Owner's Name: It)(,t C 7h o n _S Pr? o <br /> J / a <br /> Property Owner's Mailing Address: 7J5 0 S , !S.d i 'S L ok R_ 10 y^ Ali'4i.-eA I S9SI-3 IL. n <br /> City State Zip ° v) <br /> Property Site Address: SA wr( f (4 S a bOY R- o y <br /> a <br /> Contact's Telephone Number: 6 S) - 02 )ii - Li 7 J 7 d <br /> Contact's Email: d 0 u_ ,�/t OM.ioS(7)I 5� QQ G( D S , ad ry) <br /> **If staff has a questionbout this Application,you will be contacted via email. Make sure your email address is legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov oai' b <br /> b0 <br /> Legal Description of Property: Go74" / CSM4 1/ 29 4, /J R d <br /> Section#: Li 3 Town#: 21t`; N Range#: /6 W Town of: (7t� )6;i) a .' oc <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v, <br /> ii <br /> Tax ID#(1-5 digit number; found on tax statement): �' 3 `1S" 7 <br /> \tJ d <br /> Proposed Use of Structure/Add'tion:1 ,5—j tr r ct J - <br /> Anticipated Start Date: g cR., J t� 0� Li (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> J z <br /> Building Contractor: Sewer Installer: y 0 -0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z �` VN <br /> o <br /> Aid 74) be. U Sea/ -g►^ A u IAA 4 h 114 4 1'74a74o,i , iN k <br /> C) Fe,//O w ),v,1.47 q 4 4O1/1 a s //s 7`61 /y G q O 7 7co. CA <br /> a Fee Rec: /15Z)4P <br /> ° Check#:33q-3 <br /> z <br /> r <br /> -C <br /> m � � <br /> . r _ .^�_. <br /> IF <br /> Date of staff site visit: 9//VZ4Z7 Ini 'als of site visit staff: f 7 a Cr'o3 > L <br /> C C' <br /> APPROVED BY LAND SERVICES OFFICIAL: '�"" ` DATE: 9,Z0/ZO 2.9 cipr.., (- <br /> us,UPON APPROVAL: APPLICANT MUST POST COPY OF o= N <br /> P <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT j IT <br /> Page 1 of 5 LL -= <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />