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CIO <br /> LAND USE PERMIT APPLICATION—Burnett County 71 <br /> , WI b r <br /> a s <br /> z �d <br /> Applicant Complete All Sections Below This Line c kn <br /> Permit Types and FeesfPlease,check appropriate boxes) c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <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 /> G� �f <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> �' fa <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 /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. 5 rD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o <br /> Property Owner's Name: �e t lU S <br /> • '' -- � jj Al <br /> I �' AA 1 1, <br /> Property Owner's Mailing Address: �' IZ 6l F I l G 6l6l Id1jc I►'`�' ���_I 2- r) <br /> � �� City State Zip <br /> Property Site Address: �gnn"1 S,q l &)Lc t Ne -PML�-`�'1 i�T, o <br /> Contact's Telephone Number: �tp3-' � ' a <br /> ` <br /> Contact's Email: Q _ Anu� ���� � Sply , C M <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: GBurnettCountyWI.gov °q <br /> ou <br /> Legal Description of Property: YJ' riJ'1 fi to- �.'�" 0 f5wo �? <br /> Section#: Town#: Z1,N Range#: /3— W Town of: JjAty�elvi ' <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro erty a e.* En <br /> PS � I SY P copy P P Pg 7a <br /> o w <br /> / x <br /> Tax 1 D#(1-5 digit number;found on tax statement): _j d <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: P4 . iJ j C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) r , <br /> Building Contractor: � Sewer Installer: /I/UJJ Ln <br /> O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> Q1W A be- usc.al 4r AuwAav�, �nal�,i4�iorl . <br /> M a te- S u m 4 m e C-7L /D S.r-t4O a61L c d o vtq A)O✓'/A M <br /> 1d-11- hAe-0 Fee Rec: <br /> ° Check#: 7,qy <br /> r <br /> z <br /> r� <br /> n <br /> m <br /> Date of staff site visit: ZOZS I ' ' Is of <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z� Z4Z m co <br /> UPON APPROVAL: APP_L CANT MUST POST COPY OF sm ro C <br /> 00 w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = C Page 1 of 5 C <br /> Burnett County, WI Land Use Application-Rev 11/2024 <br />