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LAND USE PERMIT APPLICATION— Burnett County, WI rFi <br /> Applicant Complete All Sections Below This Line - is <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 _ <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 "- �` <br /> Filling/Grading $150 Boathouse $500 _ �'�y <br /> �p s v ' <br /> V 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 /> 7 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> r- - <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: f j 6j je64-4- e 61?057 T — �( <br /> Avenl '` 1q tJ <br /> Property Owner's Mailing Address: I 3 3� i--)a,Y 1�G'vJ v (v 'L I I*, /�/�� J <br /> City State Zip3 <br /> Property Site Address: W L r 1 Yo� ' La V;,i l T stiZa Z. < — <br /> Contact's Tele hone Number: V <br /> p tei -SH0-03ajs (a (A- 01-1161 <br /> w <br /> Contact's Email: OD yve JY(J k`_t Q 0 ti • co YY-1 0 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is > - <br /> legible and your email provider will accept emails from the following address:'((i;BurnettCountyWI.gov - 'I. <br /> czKa <br /> Legal Description of Property: (��`e r po-14'\ Abo .f �t 0 a 1' vitc4s_ tor N <br /> Section#: ID Town#: 1 t-i'�N Range#: gin W Town of: ae.( Cb V) • ___I <br /> *.4ttach additional page if needed.lor lengthy description OR attach a co 71.of the deed OR attach tax system property page.* 1. <br /> II � <br /> Tax ID#(1-5 digit number: found on tax statement): 3 lA {q 63 _ <br /> Proposed Use of Structure,` ddition: Q I <br /> Anticipated Start Date: min0 (Home Cabin:Commercial Business:Bedroom:Deck:etc.) 6'0 <br /> Building Contractor: Sewer Installer: <br /> s 0 S W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> rii <br /> 0 flpH— 11,DIA) cord,HAD-) DI vii-R -2Li--2.3 < <br /> rrt <br /> zn`I r �� <br /> Fee Rec: <br /> Check#: (203%1 <br /> r <br /> .r, <br /> pc <br /> M <br /> Date of staff site visit: 0141/A 1 f �Initials of site visit sta � �a3 �a ���-- <br /> APPROVED BY LAND SERVICES OFFICIAL. -) DATE:f o 3 2Q2/ 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 <br /> ins <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> Page l of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />