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Ln <br /> r- ro <br /> LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a <br /> Applicant Complete All Sections Below This Line ' a <br /> Permit Types and FeestPlease,check appropriate boxes) i:z 2: v` <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <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(ly)Structures $350 0 <br /> Filling/Grading $150 lBoathouse $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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 <br /> Property Owner's Name: C.p r e l 941 a e r S , <br /> a � <br /> Property Owner's Mailing Address: 2 1 5�4 FC Rat 7a ti ev •f e 1 WX <br /> 25( I c le L0.ru- ^P—+' City State Zip <br /> -7O Property Site Address: � ~ O I(6 ` a <br /> < <br /> o N <br /> Contact's Telephone Number: '71 r- 6 N 5-- <br /> d <br /> d <br /> Contact's Email: To iod o w,� e X i-Er;o+ S t l GtV 6 Ma,/ ,e a-'y <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ro C,b <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov 00 <br /> Legal Description of Property: L Cl 1 c't MCA pl e e d N <br /> d <br /> Section#: 3 Town#:�N Range#: 16 W Town of. ,n e e v,,oek C N <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* v� <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): 3 6 C— g W <br /> C7 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: March pi i h aO a.s (Home/Cabin;Commercial Business;Bedroom;Deck;etc) W <br /> Building Contractor: Cc,,-e Y t3a v e Sewer Installer: LA/c Pi (v4 S kC I m <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 z a `O <br /> o co <br /> Q Y►�ee� all s,6� ack 5 <br /> s <br /> 02 t7wet�,J1� >'10� exceed 3 beciroa M.s per 6AA) — z5=T c7, y co <br /> 1 Fee Rec: <br /> ° <br /> z Check#.1715, <br /> r <br /> -C <br /> m <br /> v <br /> Date of staff site visit:3 5 Initials of site visit staff. npj f- ` <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 1 DATE:t. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />