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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> a � � <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and FeesiPlease,check appropriate boxes) @ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v� p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150w , <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 � <br /> ~ l <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk <br /> Bunkhouse $250 <br /> Driveways/&Campground Structures $125 1 IWI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R. <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 2 v` <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. z <br /> 0 <br /> Property Owner's Name: R06erl � Co hn le D iLb e-I r <br /> o � <br /> Property Owner's Mailing Address: On P—leva, W 5473S e. <br /> City State Zip 3 -- <br /> Property Site Address:��� Qi `7 P l roc, knD h Rd, Doh rl., W i 5'+830 0 <br /> Contact's Telephone Number: 716 <br /> 5 l�5:L `►J d <br /> C( <br /> 1I © gi-naa , Com <br /> Contact's Email: C�GI�b I <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °0 <br /> W � <br /> Legal Description of Property: 15t Ot, 8 k bo►N Pine knoll 5 ub d i V'1.D h 61 wk 4 <br /> �Q_ g •�� Sit Section#:fir _Town# N Range# W Town of. (I� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 'p <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: A an Kbc)i.Lse- � <br /> Anticipated Start Date: 1. Z)2 S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ` w` <br /> Sewer Installer: W 4 J e, R u b b 0(rn 61 <br /> Building Contractor:e U L(l r � e li-C, 0 <br /> AREA BELOW THIS LINE FOR L __AND rSERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: > 1 .� <br /> Qr Folloto <br /> Z Fo 11 o►,� all ►�a�li�0„5 0 u �l�o u s� c9 vee�✓�cr+ vt�o.� QS < <br /> do <br /> Ce,r:ti ya�od 9 3 X � 74 4 Fe Rec: <br /> 6k►1lvnOVSe <br /> am <br /> Check#7 [�67 <br /> per 5�N-25-21. <br /> Q <br /> Date of staff site visit: (v 200 Init is of site visit staff: 'r {Q7 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z02 co m ` a <br /> won w <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF = � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />