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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line o c4. <br /> Permit Types and FeestP/ease,check appropriate boxes) j Cl. <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 00 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 7O <br /> Accessory Structure(Garage,Shed,etc.) $150 . o <br /> Addition/Alteration to Accessory Structure $150 FD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125, WI State Statute 59.692(1v)Structures $350 °r» <br /> Filling/Grading $150 Boathouse $500 <br /> a, <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. '5 <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c— • <br /> z <br /> 0 <br /> Property Owner's Name: a c r. A e_- K? t✓i` o IN Vl <br /> Property Owner's Mailing Address: ( gb 1 g 5 -h") , 6. n <br /> / City / State Zip ° ' <br /> Property Site Address: g�a 0 ? � A7i1 �� k'1°4s4k— _Ltl7— V }� Z G <br /> Contact's Telephone Number: COla) F6 — �3�-"_— �T z lb <br /> Contact's Email: G(eW/®529A.14 i/C-c>in N 4 <br /> **If staff has a question about 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: @BurnettCountyWl.gov 0 °o <br /> cio <br /> Legal Description of Property: SAW• 1 (/eh L o! $ /3 . O <br /> Section#: 02- Town#: 12/0 N Range#: ic W Town of: act e/eS on z. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement): . 3 <br /> N C7 <br /> Proposed Use of Structure/Addition: �(-1`5la ,�6 frt/f -? I�' /7 -m ! oc° <br /> Anticipated Start Date: (Home/ abin;Commercial Business;Bedroom;Deck;etc.) W <br /> x ...0 1v <br /> Building Contractor: Sewer Installer: E p W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> D ii---e+ a S-e-i-ba r ksri< N <br /> m <br /> cA <br /> m !'a Fee Rec:/2 <br /> °z Check#: i 0 <br /> r- <br /> Dili <br /> Date of staff site visit:ID 020241 Initials of site visit staffPo y <br /> EEra' 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: JD`/6/202q cp.:,. m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF I s I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 11 I _ hi <br /> Page 1 of 5 - J�1 <br /> Burnett County, WI Land Use Application —Rev 04/2024 <br />