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LAND USE PERMIT APPLICATION-Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 0 cn <br /> Permit Types and Fees�P/ease,check appropriate boxes) ° <br /> \ C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 lam-+ <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 /> C) <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 1 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. 2 <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 /> z <br /> 0 <br /> Property Owner's Name: /n, S N <br /> Property Owner's Mailing Address: 76 � )%d t� t L If /� n. r� t�'1 L'�i S l- , OD <br /> g r City Stat Zip � <br /> Property Site Address: 7� "� Ao(tiF hn �!�17 % r.l ��/ o <br /> zh <br /> CD <br /> Contact's Telephone Number: ��h S(,, ' 75/7 2 a <br /> Contact's Email: 5 60P L % I Z r' ?I� CD <br /> - <br /> **If staff has a question about this application,you will bi''contacted via email. Make sure your email address is b <br /> legible and your email provider will accept emmails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property: 7-('. /9 Koct r-A h.K b 2. b-�18� tl S; ,�j �J't` o <br /> Section#: _Town#:_jt_N Range#:_jj� W Town of:��l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 70 <br /> � o H <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: 14a,01 a cl per' H <br /> Anticipated Start Date: ( � _�� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z -t F- N <br /> Building Contractor: jy, Sewer Installer: y F N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> m � <br /> lO ftl6et ALL JETBACV-S < 6� <br /> m <br /> O A dl- 'fb 17 USEI, PoR ffun.«N e41y1rf"0A/. _ <br /> Fee Rec: <br /> z Check#:. <br /> r <br /> -C <br /> m <br /> O ,. <br /> Date of staff site visit: Initials of site visit staff: > <br /> APPROVED BY LAND SERVICES OFFICIAL: ► DATE: q 12OZ5 b m ca <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CA <br /> v� na <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w2-j <br /> CD <br /> Page 1 of 5 ' <br /> Burnett County, WI Land Use Application-Rev 11/2024 =-=9 <br />