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LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> 1.4 <br /> Applicant Complete All Sections Below This Line 0 c4. <br /> Permit Types and Fees:(Please,check appropriate boxes) , ° <br /> C7 <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 ..Q NO <br /> L <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 gt <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 F. O <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `q c— <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. A*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. N <br /> Property Owner's Name: V t t,/V { Y'-C- '-' <br /> Property Owner's Mailing Address: 13 Z7 1 L! V tMk NUJ r`t\ 4� 1 d4 S 3 I <br /> L G° I.� � N <br /> i <br /> City State Zip <br /> Property Site Address: --) ' �\���J �l t #�T (, o N <br /> Contact's Telephone Number: ith < G� l-Q i' (1/7c you l J 6 t ii " G 49 G,-� \ • a <br /> ° <br /> yJ d <br /> Contact's Email: pa°(- * Si ©t. 5-(: a Cam)._- ( .- CZ cis— CD <br /> **If staff has a question about this application,you will b'e'contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov c b4 <br /> • <br /> Legal Description of Property:4-04- 2 Gsrr j Eg? VCL 2/ 2 22 3 d N <br /> �' �� N Range#: I( W Town of: W t 0' N <br /> Section#: •� Town#: `�' / 1 W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): ,�b <br /> C 7 r c e <br /> Proposed Use of Structure/Addition Ci;fry / '00 --t- 1 ✓-•-.r•c�e H v 1 <br /> Anticipated Start Date: A,�4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> i a <br /> is <br /> Building Contractor: 1 -P- Sewer InstallerWoA (1 Cyk 4r% N ~ t <br /> 1 % <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m \(1' N <br /> THIS PERMIT IS SUBJECT T O ALL CONDITIONS LISTED BELOW: z z VI0 /�oT � .be US/ tor' Lmenl kQsI/�744'I10 <br /> .., <br /> ri <br /> 0 4 apply -fir a s,'€ a//ass y ia�is zx, y <br /> (9 /� <br /> �// // Fee Rec: fib <br /> i4.il /✓1JDDtf/iM4/i4yJ41U5� ke. 4)/ele GUT€ __74 4e_, z Check#: _/ <br /> SCP1 i fart' system si /)- 2-2— ZSD, <br /> m l J <br /> < r— <br /> �J CD <br /> DA 0-vW c Inn <br /> Date of staff site visit: /o/3/zO Zy Initials of site visit staff: �/. m 2 rt �L <br /> /J <.3 -v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /�/7�U Zc/ m _ <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF f <br /> �Z N. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 �� J) <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />