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LAND USE PERMIT APPLICATION — Burnett County, WI g b <br /> Applicant Complete All Sections Below This Line = a 1 <br /> Permit Types and Fees(Please,check appropriate boxes) C7 (3 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ° K. <br /> � <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 -- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 c <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 el <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. cp <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> z <br /> 0 <br /> Property Owner's Name: 120,ik. I i)• Cu ,, k b.ti d 144 t'i R•a •CcrAt._ 0 <br /> a <br /> Property Owner's Mailing Address: e L Z P21 e c.k (3i'c,,r T'r i. iJ a...42 u-f tJ f- 5 Zl 330 E. ENL e <br /> City State Zip E <br /> Property Site Address: g(„1`5 2_. 131 c:.e k f Wg=r 1 r( • Ib cc..11�. r i�: Itii 5 415.30 g <br /> •° g r <br /> Contact's Telephone Number: K A tit (_Lz K 2-4 ?,4 55- o 'I363 i ?t.1-‘,( 1(5'?33-0 55-- ae 11 <br /> Contact's Email: Kt r I3.1c` e., C rv‘et; I .. 0c 4'r� CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is -o Q <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 00 <br /> oQ <br /> Legal Description of Property: (2)(r H C t( 16E A R. /A C? E:� 1. CI i 0 ° `D <br /> Section#: 349 Town#: LA ' N Range#: i 1 W Town of: 5 L)i`,S5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ri) ° <br /> x <br /> Tax ID#(1-5 digit number;found on tax statement): Z.Z 5 7 3 c v <br /> Proposed Use of Structure/Addition: S-i-C .i;`e e, 5 he cl / WI.:: t `,1,u t' —i z N <br /> Anticipated Start Date: Q c 1-o L. r 2 C 24 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) —' NI <br /> x <br /> C VI <br /> Building Contractor: i L,A L'A a-S'•r Sewer Installer: Ni f A J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> m VI <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o Po <br /> 0 Mw- oa r. StA-baciS ."--.17<4 <br /> ri <br /> rn <br /> N <br /> Nod- 4/3 (,(,t-eed —fir VIULMcIA'► I b1. '°., cp <br /> in215 - <br /> Fee Rec: <br /> °z Check#:''j 259, <br /> r- <br /> -C <br /> rn <br /> e) <br /> rn <br /> rn <br /> F>i r- <br /> 2 3/ üz / Initials of site visit stafftIT <br /> Date of staff site visit: / <br /> APPROVED BY LAND SERVICES OFFICIAL 1,1 DATE: /O/3/2D2 <br /> m CO Cf) <br /> c tilt <br /> rn 'C1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 'a _► <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Inn <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 1 .-d <br />