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Cn <br /> LAND USE PERMIT APPLICATION—Burnett County, WI It r <br /> Applicant Complete All Sections Below This Line 0 cn <br /> Permit Types and Fees(Please,check appropriate boxes) .17 ¢ <br /> b <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 9 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C3� <br /> Accessory Structure(Garage, he etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~ <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 j IWI State Statute 59.692(ly)Structures $350 r ` <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 <br /> �' <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. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> 0 <br /> Property Owner's Name: 1M o-r y (�j e '� Y\ S 'G�� r\ S J—r w S-E H <br /> Property Owner's Mailing Address: 10 2 D (Q✓\ C-o k-+- M a k+o nn., J i. TIN S S t 15- <br /> City State Zip <br /> Property Site Address: 2.8 0(o S o. J v h►�5 o rN L,A k e R W eb S 4 e % WX- <br /> 5Af 69 '3 <br /> CD <br /> Contact's Telephone Number: (o) 2. -2 O 1 - 13 3 T t-w. S K n e S <br /> Q d <br /> Contact's Email: "t—S (4.%A_n e S ✓YN 0.i C a VVI fl <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is �, b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov U° 1 <br /> Legal Description of Property: 5 `i +-4-'0'-Gh e d d <br /> Section#: 23 Town#:_ © N Range#: 6 W Town of: ® 0.K ( 0. h d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* A <br /> Tax ID#(1-5 digit number; found on tax statement): �j S 9 w <br /> 0 <br /> Proposed Use of Structure/Addition: S C-r'e e Y1 r'o o Van S h e 01 <br /> Anticipated Start Date: tj t - 2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> af <br /> Building Contractor: 5 n S e ct C e S to n r o o w.S Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> r z ti <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z PC <br /> d <br /> dz Nor To RF uSEp POP, ffuw"A-1 ygBtTAT�ON. <br /> ® EPTIC TH/WC 003 To W 5ir'CW2ED 8Y L,OCIC � CIAMAK jaiy (ol/SIZo25. <br /> o F0eeRec: <br /> S ���•� <br /> Check#:12 3 1 <br /> -�.—.1 <br /> Date of staff site visit: 5/12 25 Initials of site visit staff: O$ a;0- 77 I M <br /> Cn Go <br /> APPROVED BV LAND SERVICES OFFICIAL: 1 DATE: 5113120Z5- <br /> D C <br /> UPON APPROVAL: APPL ANT MUST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> Page 1 of 5 C� <br /> Burnett County,WI Land Use Application —Rev 11/2024 <br />