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LAND USE PERMIT APPLICATION —Burnett County, WI IV <br /> a <br /> Applicant Complete All Sections Below This Line g <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> c <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 }ate <br /> / Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° C1� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 1 ` <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> >v <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> v <br /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner's Name: ( i$ , Q�r r i c� o N <br /> � � /'�� 8. , <br /> Property Owner's Mailing Address: 5155 docQ 0l.�u�'rJ"S Syr+,0/ N <br /> ii i. , City State Zip <br /> W Property Site Address: I L F0 i V1+ lga s0461vle/, , wT 5 g 8 Q l a <br /> CD <br /> _ CD <br /> Contact's Telephone Number: G O R, 6 Z.g, <br /> Contact's Email: pal S f-Y r-efrt-Uts ►1'►(0(. C 6i/►/1 <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: (0BurnettCountyWl.gov 2 <br /> L�� 2 Lstr J('1 Fl32 0'34Z5g5) N S'Legal Description of Property: (io,( "s, ► - F WL; y U m y t L,fs w <br /> Section#: rL� Town#: t 0 N Range#: q_W Town of: 5C(P+f N �1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> d <br /> Proposed Use of Structure/Addition:—�ReD I QC� Z,d oy I,q()yr q 1 r.a N bt ly fo Cy c49-)5 t&fs fa 10.kie- -� Q <br /> Anticipated Start Date: a yr!p uur cY (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor:f�jo/'-lt(,A75 /�am.,2_ Sewer Installer: J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: > <br /> D wdb&)o-j Wd4h W �V �k ato" 5 <br /> &and�95 uvot-e. 4-t/lm Fee Rec: 15)?a <br /> 0 Check#: <br /> J W3 <br /> Date of staff site visit: 3 5 1 Z02q Initials of site visit staff -r t L Fa) n-T <br /> I . 2 <br /> APPROVED BY LAND SERVICES OFFICIAL A� 1 I/U � DATF,: 7 Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 ��-----�� <br /> Burnett County, WI Land Use Application—Rev 12/2023 (- <br />