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r Z <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a r1 b <br /> Applicant Complete All Sections Below This Line I\\4\ c to <br /> Permit Types and FeestP/ease,check appropriate boxes); n <br /> }4•: Dwelling/Principal Structure Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 killp <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $2 00 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk I IBunkhouse $250 <br /> Driveways/&Campground Structures $125 1 IWI State Statute 59.692(ly)StEtimes <br /> $350 r" <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year ExtenOnce) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to thormal fee. `-Communication Towers, Camping Permits&Signs require a different application form,see corrication,and fees:4.*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,e o ::t7j <br /> Property Owner's Name: A 1 '� (Le r5}u�-`tl C� ti j ! 1 �.►^ Sc �.�'�g ° o o <br /> 0 <br /> Property Owner's Mailing Address: �-� 3 5 n��'r W 1 . n <br /> �c <br /> i t- / City State Zip <br /> Property Site Address: Z J'2-&( .S+r tcq 35 �d n ✓�y l tl S 4k�© c <br /> c <br /> Contact's Telephone Number: 7/s 7 0 2- <br /> 7 d <br /> w <br /> Contact's Email: ad a yr �/ Q ockd S lion C tJ--,�-)rr1 S a C—,-✓- <br /> **If staff has a question about thik application,you will be contacted via email. Make sure your email address is C <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 5 <br /> Legal Description of Property: °O <br /> AJ Yz - �� A' � F•� w3 of R0 P6 i�Gr 'q-8 � d <br /> � II-- �j � (1 <br /> Section#: Town#: N Range#:�(W Town of: ��L� ►'�GC 0' NN <br /> 1 <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): 3 <br /> C7 <br /> Proposed Use of Structure/Addition: 146 M y <br /> Anticipated Start Date: 0 , +• Z PZS (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: DtD N s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> Dwel 11'14� clot �o ex�e.c� 1 bc�.voo say l' ry # �zz-0�3 <br /> ® 4 rrs 1's aA c�'� ��i�--�a�r' Boa v�v'7� �e 9craa9� <br /> l <br /> �p q Pj r'f t t9 / �• Fee Rec: VW—.00 <br /> 3 K � U�G n�Per4e `moo o 74t/M b P eA'V-Per MA I /,, z Check#: 570 <br /> Ld140� q►(owa1'0 c0w^te-Oc44� �eV 320- Z2 �-���, <br /> or4H0,460— <br /> o <br /> Date of staff site visit: g ZOZS Initials of ite vi ' ff: i 3 <br /> ram' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ✓� I ZOz.S— _ <br /> CD <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> CD NJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> CD <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />