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. LAND USE PERMIT APPLICATION - Burnett County, WI a I <br /> ro <br /> cn IN) <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and FeesPlease,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p 0 <br /> Accessory Structure(Garage,Shed,etc.) $150. Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> f <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e IQ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 " + <br /> . ,' <br /> Filling/Grading $150 Boathouse $500 t <br /> w l <br /> Solar 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 /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. • 6 <br /> o , <br /> Property Owner's Name: 9ez y pr,At it <br /> /� n o 1 <br /> Property Owner's Mailing Address: J 03,2 „? / : l,.111 /ec�r�C/ .// V. .5 5130 n NI <br /> City State Zip E -- <br /> Property Site Address: 6---Q, ,--7?,.Q- Z o N <br /> Contact's Telephone Number: 6 2, - r/ G vy <br /> CD <br /> Contact's Email: Uk. ri^y.0- .-e t/V /•'v�- m G e s C <br /> **If staff has a question abut this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @B/umettCountyWl.gov °c °Q N <br /> oo <br /> Legal Description of Property: 3 CD 5 2 2 T�'Lv_I i. /lpc.�' t ,O it d c,1/ L .1• S y ��� o <br /> Section#: 2.( Town#: y/ N Range#: // W Town of: _Yee,,'s,j 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* e, <br /> Tax ID#(1-5 digit number; found on tax statement): 2/ of sy <br /> W N <br /> Proposed Use of Structure/Addition: (�r�p w <br /> ,- 7 / , /ci 4y y ,-3, <br /> Anticipated Start Date: (Home/Cabin;Cofnmercial Business;Bedroom;Deck;etc.) <br /> x ,l7. <br /> � 0 <br /> Building Contractor: /11,1' car,, ?:S p / Sewer Installer: <br /> En <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z po <br /> v <br /> CV No -b be used -C-b'r 11,w4n r 1Awb +r� <br /> Fee Rec: <br /> ° Check#: 3 353 <br /> z <br /> m <br /> Date of staff site visit: /OfZs"I Initials of site visit staff 3 <br /> APPROVED BY LAND SERVICES OFFICIA : DATE: I0//661202y 7) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 w n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Pagelof5 Na' <br /> Burnett County, WI Land Use Application —Rev 04/2024 QL J <br />