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-�&KlCu I OACn CAfPr VC d <br /> LAND USE PERMIT APPLICATION— Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and FeesfPlease,check appropriate boxes) ° (T <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4-1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \9 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n ~ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 c 1 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 N <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> �a <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. t- , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> O <br /> Property Owner's Name. U VI (_ LQi&e L v o <br /> Property Owner's Mailing Address: X)1 Leatz"' D 4l UJI S a ` <br /> ,L J �- City S t Zig X <br /> Property Site Address: QG Yl L�( R. I�t lRy Uj( Y�3 a < <br /> 0 y <br /> Contact's Telephone Number: <br /> 7/3r -- 7Y9 - 0 -. D <br /> ' b�s�y@ <br /> U /a GContact's Email:S � 6k- Ut ��a6e C 001 cen+u-y�el. N <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is b Z <br /> legible and your email provider will accept emails from the following address:@BumettCountyWI.gov 04 a <br /> Legal Description of Property: GoU -u f <br /> Section#: _Town#: q(-) N Range#: I�' _W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .� <br /> Tax ID#(1-5 digit number;found on tax statement): F g 1-7 2 <br /> �y, o <br /> Proposed Use of Structure/Addition: e/�/ &14O A l G N1 <br /> Anticipated Start Date:M aq O Q jc— (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) kA <br /> Building Contractor:0CL R C `/Ou/y rt&8 Sewer Installer: 0 pD <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z J <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'z <br /> 0 <br /> y ` <br /> C7 <br /> [i7 <br /> !A <br /> a <br /> -� Fee Rec: <br /> ° <br /> z Check#: 27251 <br /> r <br /> -C <br /> X <br /> n <br /> -` <br /> < <br /> O <br /> Date of staff site visit:4061Z5 Initials of site visit staff:-PB > �D jl <br /> u>cc , <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 DATE: jZ?/A0Z5 tD c <br /> CD CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w C <br /> Page 1 of 5 3 <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />