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a LAND USE PERMIT APPLICATION —Burnett County, WI b <br /> Applicant licant Complete All Sections Below This Line �! <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> G <br /> Dwelling/Principal Structure $300 x Addition/Alteration to Dwelling/Principal Structure $200 i9 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .� p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �q_, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 r V` <br /> Filling/Grading $150 Boathouse $500o <br /> Solar Panels(Stand alone or roof mounted) 1$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 /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. n <br /> z <br /> 0 <br /> Property Owner's Name:Chris and Kelly Cusick _ 8 <br /> Property Owner's Mailing Address:561 Marmik Cif Hastings MN 55033 w <br /> City State Zip ° <br /> Property Site Address:27474 Greer Rd Ext <br /> Contact's Telephone Number:715-259-3257 (Northland Buidlers Inc) a <br /> 0 <br /> Contact's Email:northiandOO1@centurytel.net <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: @BurnettCountyWI.gov .� "` N <br /> Legal Description of Property:Lot 4 Sheltered Pines& pcl d <br /> 35 40 15 Jackson -a <br /> Section#: Town#: N Range#: W Town of: �' •.f <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach lax system property page. <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement):6298 ek 74 <br /> Go+�G�' <br /> h t addition o house <br /> Proposed Use of Structure/Addition: a <br /> Anticipated Start Date:4/1/2025 (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) Q <br /> Building Contractor: Northland Builders Inc Sewer Installer:NA N <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> ' � o� <br /> c�ti c,Ue��� aye� �re_ /Z x /z <br /> 1 I V � � 1 0� qGdNW s 4r a p <br /> Z Fee Rec:0�003 <br /> �115 01, U� Q�1 `� �(P�lGtS/DI'1 c11�0W� �� 3t�_ 1g7� ° Check <br /> z ` <br /> ati a vlSlo�l I�r�l Uli'S 0 U4V')ajA�. <br /> y �4ltoa4` <br /> Co 1!' I,l k- �H 5 Pee- ✓� '1� 5 e e. l� '>�tk�►r t�e_t�»1 tie <br /> o C�7 <br /> Date of staff site visit: 3/ 1/z— Initials of site A ' ff: <br /> APPROVED BY LAND SERVICES OFFICIAL: CD 03 E; �D c � <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> o� o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , <br /> D(� D W e))Irvt 3 OMB Per U�-r 15/ 7Z990 Pagel Of 5 � � <br /> y 4v f � bBurnett County, WI Land Use Application—Rev 11/2024 <br />