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CD <br /> LAND USE PERMIT APPLICATION — Burnett County, W1 a C <br /> Applicant Complete All Sections Below This Line U\ <br /> Permit Types and FeesfPlease,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <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 /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> o l <br /> Filling/Grading $150 Boathouse $500 1 <br /> Solar Panels(Stand atone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> '! <br /> w <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> 0 <br /> Property Owner's Name: r c o <br /> o <br /> Property Owner's Mailing Address: !'f sa I j 64. e*ly W <br /> City State Zip <br /> Property Site Address: _ 3 U� � �`to Ga �u- PI-A 0a�i✓T <br /> Contact's Telephone Number: I i- 3 y 7 - B b a <br /> Contact's Email: _J_°5 �etS��__��� ✓ ���► ____ <br /> **If staff has a question about this application, you will-be contacted via email. Make sure your email address is ti <br /> legible and your email provider will accept emails from the following address: `,BurnettCountyWI.gov 00 <br /> /,�.� '\ n4 <br /> Legal Description of Property: P� 2 <br /> b CSM 4Zy7 V 1 P263 (IN l�s ) # 1(PNZ2 N <br /> Section#: �y _Town#: 4f/ —N Range#:— W Town of. .r✓ SI( <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax.system property page. <br /> N 0 x <br /> 'Tax ID#(1-5 digit number; found on tax statement):_ <br /> 0 <br /> Proposed Use of Structure/Addition: �Gt/a tie t5� K av SQ N <br /> Anticipated Start Date: �Tv t,� D et! (Home/C'ahin;Commercial Business;Bedroom:Deck;etc.) 2 <br /> -{ N <br /> Building Contractor: SoS4 Lz/Se, _ _ Sewer Installeni S ___PLLnb�___—_ N W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z � <br /> v _ <br /> ��ner is VfeS lS�ble -wr nl ee+i n) W R4k;ar�S eJ� <br /> < <br /> m <br /> g)Fb[1y,-j att ✓t5- c,+ions q re-c ord d bu.n k haAe 4oC.u.ryUP.rl.4- <br /> ' w r l f5 > Fee Rec.�- <br /> � Con U�� tco bAuir j (Wb�) �r1��2CL �or Ct�^� (LL�e51c�j m <br /> Check#: e2nfik_ <br /> m <br /> f� <br /> Date of staff site visit: -!7lql2# Initials of site visit stat : T <br /> lL,,'o ����T ' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Xz=V6 cn c° �--•- <br /> < <br /> UPON APPROVAL. APPLICANT MUST POST COPY OF ICA <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Pagel of 5 <br /> Burnett County, WI Land Use Application — Rev 04/2024 <br />