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• LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> No <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(P/eose,check appropriate boxes),' � 1-6 ,k <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 b O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure ` ct '$150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150$250 O `'° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse l� <br /> Driveways/&Campground Structures $125, WI State Statute 59.692(1v)Structures $350 .°r» <br /> Filling/Grading $150 Boathouse $500 <br /> AT b <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 YP 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. `2 <br /> -o <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. g <br /> I.z <br /> Property Owner's Name: (;._r i , 1 — <br /> ra <br /> Property Owner's Mailing Address: / d 6o K 2 3 .� F. ` <br /> ""� / City State Zip a up <br /> 7/ S Ca:,.+f k(l i� Gt 2f r1Li w/ ,, $ L/8i S < <br /> Property Site Address: 6 o y F �. <br /> Contact's Telephone Number: A/0 j'a;' /0 i i a. ' <br /> Contact's Email: do--r/-c,h 4--1/‹05 rLe_,.Js/", c? yAE.IaJ ' C.''` <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 0° <br /> az <br /> Legal Description of Property: Pq -D'r G L 3 q N /p 4 r7I /al <br /> of e- 7 %i/4- <br /> Section#: '3 Town#: 3 9 N Range#: I W Town of: Al 014 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o ��� <br /> Tax ID#(1-5 digit number;found on tax statement): ///`2 5 ' (.) z 5 <br /> Proposed Use of Structure/Addition: -� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: up <br /> y <br /> i , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> o � o <br /> / // // .. <br /> �/5 /S 4N q P� �c -E^u c.�- p e�^Un,�f' -�/" � a qf-�/"717dN �j <br /> ie_. F4rQpe. c GG <br /> 1 y <br /> 0 p r9e /P07� 7� be_ /C/S J�JI" `?UGti9N /` 'q ,7 ,�/��o Fee Rec: 3 — <br /> Ci) tvl.s. OF this atce /eS [,0/Y"ArDl tile. 5!�ore.l'a a greq., So z Check#: 113 <br /> Ca>M f ties G Pe, l/`e9 N/a 744 Ca 0-pear ilex1r ne. e o etc <br /> / (*(iy Acii <br /> Gat N se.. U 5 - r WO t^Q., tto N 30 (icflYS low y to r; u571- h p, <br /> S f'o r7^ed or o f-F 7-be ion er^ t t o7 t P.f^ 3 3S cia ys 1O e#' y.e0✓'• o �-�= <br /> Date of staff site visit: 9119/2O ZC4 Initials of site visit staff: // r, <br /> E. Cr> tJ u <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9/�/Ze Zy g W l 6•l c <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N <br /> Pagelof5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 LL____ <br />