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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 0' v <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> CD <br /> P. <br /> G r- <br /> x Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 S S U1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � 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 r <br /> C t <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 /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0> ; <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 06 <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a' — <br /> z <br /> Property Owner's Name: .�try-m cc.p l�L -1--(Lc wk. o „NC <br /> Property Owner's Mailing Address: r1 Aix. S;T e, &a s'b >.9 <br /> City State Zip ° v) ....1Property Site Address: k(e.� ' �rq//—r//•0 tv T-�t..�- p 1Z L • L D E�BS4El.I uoi 5 4%S 3 o N <br /> Contact's Telephone Number: 7/$ 566- /2 S -7 I CI S lcl,— 07 3 3 a <br /> d <br /> Contact's Email: LA.k.%ay 'tiJr \--► K J O i.....r\ old• . wvH c% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is --0 <br /> legible and your email provider will <br /> lI accept emails from the following address: @BurnettCountyWI.gov N <br /> Legal Description of Property: 1/2• vV)/2 a/ SE t7 N <br /> Section#: 0 3 Town#: 3 g. N Range#: 17 W Town of: lJ '►,c,lS 0 I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N u o Tax ID#(1-5 digit number; found on tax statement): )3u2. <br /> ' <br /> C7 <br /> Proposed Use of Structure/Addition: op <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> s C N <br /> Building Contractor: Sewer Installer: y <br /> v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zpo <br /> 10 i pe i al ;C-i'2ar S < _.1 <br /> 011),A/curtl no --iro Weed 3 bedrorriS slZ1!-Z/17 <br /> v, <br /> :� ��f�lJ1 ZDZy � Fee Rec: �- <br /> d fn'tqbe ab�orn, ar Perm/ z Check#: `�C)0lJ { <br /> mJU <br /> O m <br /> Date of staff site visit: iet/242g Initials of site visit staff:‹/ (g 0, <br /> APPROVED BY LAND SERVICES OFFICIAL. / -1 DATE: /D///2&1-/ ro <br /> 0 0 00 G� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c <br /> ¢• r ? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g L— EN <br /> Page 1 of 5 Z~ 'J <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />