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LAND USE PERMIT APPLY'A.TION - Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and FeesfP/ease,check appropriate boxes) o <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 W <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $2S0 �, N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) 1$150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <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. <br /> I� z <br /> i <br /> Property Owner's Name: MOLAC fiz o <br /> Property Owner's Mailing Address: 11/ ao hlwl <br /> City State Zip <br /> Property Site Address: _S(me c y <br /> d <br /> Contact's Telephone Number: p l yj' 97 y <br /> 7 9� ° <br /> op G <br /> Contact's Email: J&jnjr S dl ore CiX_) O,Met'l�a Co!fl <br /> **If staff has a question about this applications ou 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 <br /> 5' <br /> Legal Description of Property: L-o4 Z CSM 6o-15 Vol ZS PQ7 Recorded IRS d0CutrprL 5G70321(X-%) d -.3 <br /> Section#:� Town#: 'LL_N Range#: / 7 W Town of: (S W I SS <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> V.1 & o <br /> Tax ID#(1-5 digit number;found on tax statement): {L 3S8'� <br /> Fl" <br /> Proposed Use of Structure/Addition: - CCe rn� 4 J4 2 j y �A <br /> Anticipated Start Date: �Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> M tt+ <br /> n <br /> Fee Rec: r <br /> �/ D/0 z Check#: <br /> Md C��la.' h 3 Z 25 � 1 <br /> m <br /> Date of staff site visit: Initials of site visit staff:5-9-20z En <br /> } h G <br /> APPROVED BY LAND SERVICES OFFICIAL`�l�(.�.�,GIO l�(�1 DATE: S I3 ZU2,5 1 <br /> .^ <br /> UPON APPROVAL <br /> : APPLICANT MUST POST COPY OF jl-f <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD <br /> C' <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />