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LAND USE PERMIT APPLICATION— Burnett County, WI a i <br /> F tv <br /> Applicant Complete All Sections Below This Line 5 c ?� <br /> Permit Types and Fees(Please,check appropriate boxes) C7 Es- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 e "� <br /> fAccessory Structure(Garage hed, c.) $150 Addition/Alteration to Accessory Structure $150CD <br /> Accessory Structure(Comme ' 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 S" <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 6' <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. k. <br /> • <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. S o <br /> Property Owner's Name: .. �t(5 bind c---ile_/-(,..\i, e v, V i S TL b -i' <br /> r' MailingAddress: , /i/C / q to rl- /`-'E e? ✓/ Yr 1 c%"/f I. <br /> Property Owner's '7 7 J l� l 5 <br /> ✓ /- r / City, State Zip 3 <br /> Property Site Address: /3(7- /-[�/eS "a l l0• / (Y/Lttist U t-r to// c <br /> Contact's Telephone Number: / 63 - 232 - 33 Z- 6-/�/ .6 .. <br /> Contact's Email: 51L- 1 `Tc- ! 4 C/0 U " L <br /> 01**If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails fromA) cfollowing <br /> the address:@BurnettCountyWI.gov 8 <br /> crogo <br /> Legal Description of Property: i/v I,n �/ n <br /> Section#: 1 ! Town#:,3 N Range#: ( W Town of: /�.Q/�1-- /t6 4 ll /L g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c' <br /> cTax ID#(1-5 digit number;found on tax statement): 36 75`� d <br /> Proposed Use of Struc A diti n: 1 E'-4 c <br /> W <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedro in;Deck;etc.) . *\ <br /> Building Contractor: Sewer Installer: c <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/C NDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6 <br /> 0 A 4 i.lSPd .I,, Ai., 4lai,/Q17�4. ,:i <br /> n. <br /> ,x, , <br /> ,., <br /> U1 <br /> Fee Rec: l 57.1 <br /> 42 <br /> 2 Check#: ciOL9 N <br /> Date of staff site visit: 9/l9/ZD ZY Initials of site visit s ffri// acn co <br /> ii a ii <br /> me r,, 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: _ ATE: 9/2 /2e Z/ :._ �'UPON APPROVAL: APPLI ANT MUST POST COPY OF 0 o `T' o <br /> CDC cc <br /> D PERMIT APPLICATION IN PLAIN SIGHT 3 i <br /> SIGNE <br /> Page 1 of 5 --J <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />