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LAND USE PERMIT APPLICATION-Burnett County, WI ro <br /> Applicant Complete All Sections Below This Line 5' <br /> PP mp ] CD , <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> r .Q <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 C <br /> N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �� (o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(l0 Structures $350 0 0 "c <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> 2. <br /> ADSolar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year 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. <br /> b t..., <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. t <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. R <br /> z <br /> 9 <br /> Property Owner's Name: yf�L s-c?(<) L,/e. L. i-f-'7f1O,9,U ey1/4- /2 t/7 } Z �i <br /> Property Owner's Mailing Address:7'/C C; , L C Drpti if!P y 1.1/ 5 y83 i I N 0 <br /> i City State Zip < <f 1 D <br /> Property Site Address: 7 (S-- e, g, t(yo/ o H 0. <br /> Contact's Telephone Number: ? ( S— —?3 � - e',C) '2, a <br /> 2 <br /> Contact's Email: elf 4E(LCL (2 1IJ (25 -# er27- -/, Cpe,it--i CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b I. <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 5. °° <br /> Legal Description of Property: 5-4- if. A-' 71 E7147) b <br /> Section#: 20 Town#: 4 O N Range#: I L,p W Town of: D cdc Lnc) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> `, / o y <br /> Tax ID#(1-5 digit number;found on tax statement): /'/jD a / /1/5' , C3 b <br /> Proposed Use of Structure/Addition: f J 1 L f C es--) •-3 <br /> Anticipated Start Date:e S,41.1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) cj1 <br /> t1'�, o Building Contractor:.%�`Ti`[5 �1�o�%�-f�e.�5�iegeGrQn�Iler: �' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY P z y' <br /> /THIS PERMIT ISSUBJECT TO ALL CONDITIONS LISTED BELOW:/ 8 z <br /> D /h,`7 /e#tvii�7 /5 . .Ks /1 e_ Get(c k1 4- _ LW Z� TUB . O <br /> VI <br /> c e ,t, a ,,via' �i ell --/- i s rex/AA/71- ca H ie re 145e j <br /> I Fee Ree: /``��� <br /> �j'D leG�L1 e / �� e PGV i//O/7 ° Check#: I'M 7 <br /> �/s de_ co�Ai/%re��f a cs� / /i/ ozse g <br /> til <br /> Date of staff site visit: 10 i 1 t 12°214 CS 0 <br /> Initials of site visit staff COCD <br /> .o CD c _,,,� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /O�y ZO Zy 1.1 <br /> UPON APPROVAL: APPL CAN'T MUST POST COPY OF o a iv cc <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - ttl <br /> Page1of5 �. (S. )) <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />