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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Applicant Complete All Sections Below This Line i5' rg A <br /> Permit Types and Fees Please check appropriate ¢' C <br /> YP � boxes) � � <br /> Dwelling/Principal Structure $300 ,Addition/Alteration to Dwelling/Principal Structure $200fi'v---� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \i <br /> Accessory Structure(Commerciaffindustriaf) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 T c <br /> Filling/Grading $150 Boathouse $500 <br /> rn <br /> d <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P _ <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. `D <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 2., -' <br /> z <br /> p <br /> Property Owner's Name: �T y e74/ ,41le e44,n" l/ y" 4j&- 77P vt..s'7` o <br /> aW ' <br /> Property Owner's Mailing Address: 3O e 72 Ai4,2—ii, Q14M'/'I a 4/ ,4%/ s k: n <br /> /fe <br /> City State Zip �� <br /> Property Site Address: Zig /Z y s,,)„„,L:-S per,/ ' \ , jAegeoey Al t' _s*--A ''Q 7 < <br /> Contact's Telephone Number: ,Z,,A/ Z ye/ / o 4j�rR 1 " <br /> Contact's Email: �4 AAil/ie,:,~� e dM ca S'Lr 4 el" V1 <br /> **If staff has a question about this application,youi7rbe contacted via email. Make sure your email address is N b 5 <br /> legible and your email provider will accept emails from the following address:@BumettCountyWl.gov =. °Q <br /> vo <br /> Legal Description of Property: 5-2?- �ylJ/V- te/b u-'r GV Z.,.T-7 N? J <br /> Section#: 2' Town#: Lie/ N Range#: W Town of: f/ 4-4 44 t,' 4 N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* m <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): /?,,r /7 ` t W i d <br /> Proposed Use of Structure/ dition: ire y / " L'&.4,/ '‘- 57.�t/CT4-C 4R,e0f- -3 — <br /> Anticipated Start Date: (4, /�,r/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' <br /> Building Contractor: r/ L(/C- Sewer Installer: ( - t_ p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o r - <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d Po <br /> Oticlai-lion no-- \-0 tx.c e ed 200 SI + <br /> Fi <br /> CclM <br /> pwe,ia hod -Io kx�e ed bed wums S1�N 233�1� y <br /> (Q r 1'1� "i Fee Rec: • <br /> EDI�'o�lo w re (,I l ,WIQ�►/) �[ L(,( k�a rl$l a>1 t'CQ-�-I�Gt1Y2 �l�', �°z Check#:f/'SC 3 <br /> ( No S4YUc4 P a,UAv t✓1 3S% D-C 44U-1- t M <br /> z <br /> p / q l y M <br /> Date of staff site visit: 0 /1 112,02.y �'Rr it I Initials of site visit stafft"* T G l . c_'�J }P <br /> • <br /> / b n 011 <br /> APPROVED BY LAND SERVICES OFFIC DATE:�D 7/�Z—I C <br /> CD c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 3 G <br /> m m — HT <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 0 N cc <br /> `—' <br /> Page 1 of S <br /> Burnett County.WI Land Use Annlication—Rev 04/2024 <br />