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LAND USE PERMIT APPLICATION —Burnett County, WI roci <br /> Applicant Complete All Sections Below This Line ' N <br /> Permit Types and FeestP/ease,check appropriate boxes) ° <br /> O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD V.1 <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 /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <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 /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o (C� <br /> Property Owner's Name: goi 4/c/¢ he//<<� cj N <br /> 0 <br /> Property Owner's Mailing Address: 13 b SQI,Gr <br /> City State Zip ° <br /> Property Site Address:,-2 /cj c gip. ^ i >LL4- CD <br /> Contact's Telephone Number: 6,/oZ—9 oo;j .�vS 2 a <br /> W d N <br /> Contact's Email: j0cj4-z�SA c-/I{2(2i R /✓�9 / �% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property:LoT I CSM V 2-3 Fq (i '39 11218') L/670V LOT �) C7 �► <br /> N <br /> Section#: 0— Town#:�_N Range#:—jX—W Town of: /RA <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* rA ` <br /> Tax ID#(1-5 digit number; found on tax statement): v23 7 w 7`7 N <br /> Proposed Use of Structure/Addition: /haka"tj N04.SC <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> JZ <br /> z C/J <br /> Building Contractor: Sewer Installer: y J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> D nn useW CV <br /> © Dwe16r j ,n04 -b exc eta 3 b�c�rvoms per YN_ 214(-P N <br /> Fee Rec:$3co <br /> ®No a4.c�C -fi( �-Hn i S Ron-4 Uxt l +' u l Dccc4cy) 1 S L��P�V'� cr! z Check#:`130� <br /> �.� 7Z4-)Yl�t1q <br /> Date of staff site visit: ZL Initials of site visit staff:qrT a " <br /> APPROVED BY LAND SERVICES OFFICIAL. /�/�� yz� DATE: <br /> °CO m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m= N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> S �,- <br /> LY <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />