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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> Applicant Com lete All Sections Below This Line N <br /> Permit Types and Fees�Please,check appropriate boxes) <br /> n <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 I<j <br /> C V°e <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(ly)Structures $350 0 1 <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 /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. Irl <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o <br /> Property Owner's Name: 1 A t G 6 G h WLt d-t-k-{i o J lV <br /> o (� <br /> Property Owner's Mailing Address: l St Gur vril i�9 l> n t <br /> 35y C-A y. State Z'p <br /> Property Site Address: � � fa to bY'1 Vt C ► J) q — o N <br /> Contact's Telephone Number: <br /> i d <br /> Contact's Email: 1&YL e- IS-Qkl l� I IVQ:k I> 6,0 M <br /> **If staff has a question about this application,you ill be contacted via email. Make sure your email address is N ro -t <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.g v 0 00 <br /> t.o '�tVir't -St v eh 17) Tv c+s�`ve Ss lnn��s�Vd�#;vY) <br /> Legal Description of Property: v ^��l W' Ct- ZV\ KTA-6 i{ (p ) d <br /> Section#:— Town#: q N Range#: W Town of: `lac-kS�,n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page,* v� <br /> � o � <br /> Tax ID#(1-5 digit number;found on tax statement): —7 145 N <br /> Proposed Use of Structure/Addition: �D &I ei <br /> Anticipated Start Date: 2,02 1j (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> N <br /> Building Contractor: r�UMQ-6� )Me Sewer Installer: <br /> y <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 <br /> MUS+ SObac&j Cri4-ica) IDf 5e4WJ 4U sld-P prt)ff,,, 7 M i11 <br /> r� <br /> O p ��� Fee Rec: <br /> Fed Q r r k + 7 Y' z Check#: <br /> y <br /> Date of staff site visit: I Initials of site visit staff: CL <br /> APPROVED BY LAND SERVICES OFFICIAL. � DATE: 7 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> CD � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rl3o <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 =—� <br />