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• LAND USE PERMIT APPLICATION -Burnett County, WI cr " ..1 <br /> • Applicant Complete All Sections Below This Line 0' 6" N <br /> a A <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 D 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , Mita" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ir <br /> Driveways/&Campground Structures $125 _WI State Statute 59.692(1v)Structures $350 o C.) <br /> Filling/Grading $150 Boathouse $500 d �`11 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. k& <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. b <br /> z <br /> _ o <br /> Property Owner's Name: A L N /I &It-:.. and . )FC Of :n — "CN <br /> 'I `, 0 <br /> Property Owner's Mailing Address: -3 `.. ,� 6-G 0 0 R S( S / M1�L �/V lj 5 ,oi'1 � �1 rz <br /> City State Zip < 6- • <br /> Property Site Address: L 01 <br /> 0 y <br /> — <br /> • <br /> Contact's Telephone Number: 9��- 41 2`3 L./ 3 (p a <br /> dp / N <br /> Contact's Email: A h i J o 3 I -/ 7-q �f 60 a <br /> �_**If staff has a question about th application,you will belihect <br /> ntacted via email. Make sure your email address is N g C7 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov o °O N <br /> 5' <br /> aQ <br /> Legal Description of Property: L.U ( 1. C S ril 57 6 <br /> 1 N <br /> Section#: c b Town#: 3? N Range#: (L W Town of: D6-- ) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systEm property page.* 4=4 rN. v4 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 6 ( -I 2 <br /> 0 5 <br /> Proposed Use of Structure/Addition: '1 n'i- -3 CN <br /> Anticipated Start Date: � 5 A ( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t ,-,_ <br /> g - r k Ru p ND k N F(.1 <br /> N <br /> '------- <br /> Building Contractor: C, /� Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> o v <br /> h <br /> l/ 1VI�(e4 aSt+1A1 ' m <br /> < —c <br /> A <br /> © n., no- 41) .eXceed 2 bed rxomS laex Ste-2-1-2(pcp <br /> O A-f ety cdr ark acid r e by ►2.11 12A 2y o Fee Rec ID <br /> CI \ �� YYIU 5 - 2Qf�� S� Or lQ ry-e r ►n S I� r <br /> -< Check#: C <br /> DDwe1J:kn0) 110 - +0 -e e-ed 9o-C+ <br /> he ik+ res+ri c-kon rn ' <br /> c w <br /> Date of staff site visit: I D f ZI/2t2L( Initials of site visit staff: T m <br /> APPROVED BY LAND SERVICES OFFICIAL % DATE: 0/2//2(4 `•-g — <br /> � z <br /> Cr, 511 <br /> UPON APPROVAL: APPLICANTMUST POST COPY OF a c <br /> r5 N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . lnN' <br /> Page 1 of 5 �� <br /> Burnett County, , WI Land Use Application—Rev 04/2024 <br />