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LAND USE PERMIT APPLICATION — Burnett County, WI c r <br /> b <br /> Applicant Complete All Sections Below This Line 0 w ,pt <br /> Permit Types and FeesPlease,check appropriate boxes). aN <br /> C7 <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..P 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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> 31, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ • <br /> b c� <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o . <br /> z <br /> 0 <br /> Property Owner's Name: 1/4/\i\Ck CJ C�1 cj\ U . iV <br /> 1 , -)c 0-2,Aw1 NQ\ 5 5 i ' ' <br /> Property Owner's Mailing Address: als-i �1��1 1 w. n <br /> Stat <br /> Zip <br /> Property Site Address: SC\\ \- V�S`1e 1 Y V e�S Y \ale` SLJ 9. ° < N <br /> Contact's Telephone Number: 'el\S -'2�- 6-1 3S 0 <br /> Contact's Email: \(V\ GJ�j\e-O`S c C\1 C C')\'Nr\c-A-\\- ("6 C`--N 0 <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: @BurnettCountyWI.gov 0 °O <br /> 5" <br /> Legal Description of Property: E 2-0 PC E-ES <br /> I O F SA,\I S E g <br /> Section#: 7 1A Town#: 40 N Range#: t `f( W Town of: C VAC/0(NC' 6. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* rj v) <br /> Iv ° i- <br /> Tax ID#(1-5 digit number; found on tax statement):$ - L <br /> d <br /> Proposed Use of Structure/Addition: -C\(\'1.2L'\-\ — IA C)i\)\ ._ H tT1 <br /> Anticipated Start Date: I(j 12_t I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) iC-- <br /> a <br /> Building Contractor: .t Cl1/"I/) Gi i SO r1 Sewer Installer: , )l,t C d 0 6' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zpzi <br /> v <br /> Dk l;4 edi Se.,4-lixtc.kS CZ <br /> C. <br /> m <br /> (r�� <br /> CD. bwitt.k n� no4 -1-0Vt.Cee.d, LA s�,yoo mS WI-ul-27Z y <br /> a <br /> (� Fee Rec: ,Y� <br /> �/ �✓l) no 40 kcee�t �l0� l�:i5��- reS+r��-+ion z Check#: 25,,Vf) <br /> v(a <br /> O <br /> Date of staff site visit: 10115/2-0244 Initials of site visit staff T a m ko e� 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE:ID JLi Z0 V m al. <br /> --a <br /> c=p Nil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT s �-= -�' <br /> Page 1 of 5 = - ` <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />