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e . <br /> LAND USE PERMIT APPLICATION—Burnett County,WI <br /> ,ApZlicant Complete All Sections Below This Line a' <br /> Permit Types and FeesjPlease,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Y, Addition/Alteration to Dwelling/Principal Structure $200 S <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 } CT1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a <br /> N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 S <br /> Driveways/&Campground Structures $125 Wi State Statute 59.692(1y)Structures $357 ^ n <br /> Filling/Grading $150 Boathouse $500 1 <br /> Solar Panels(Stand alone or roof mounted) $i5Q 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 /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. gypp° <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. V z <br /> 0 <br /> Property Owner's Name: B D 14 a h 1'( A lU tI MA K(G KM?t 1? <br /> Property Owner's Mailing Address: CHATHAM T R ACC NewsluocNnvj MN 551 Z � <br /> City State Zip " <br /> Property Site Address: fgcv, sT o , <br /> Contact's Telephone Number: �12- M 0l - 1110 <br /> �11 iet 0 <br /> a <br /> Contact's Email: (�� ,I + a )PC I k0lf Q 141 %LF; <br /> ) <br /> **If staff has a question about this application,you will b6 contacted via mail. Make size your email address is <br /> legible and your email provider will accept emails from the following address:@a,BumettCountyWI.gov . <br /> Legal Description of Property K 1T L 0 F-61 L ClxS114 Q 906 As V,0PUvL1W 02 ty <br /> Section#: Town#: 40 N Range#: l W Town of: , LAit��7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Add'ti n: �.tAPz(14 y <br /> Anticipated Start Date: 2r )�i?' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) \ \ <br /> Building Contractor:_ Sewer Installer: ` v) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CO ITIONS LISTED BELOW: <br /> � � Z�Z�o57� ut�t i71' <br /> boun�or lllo CgA04d <br /> wtLi Ta///Dt,J A�at�15 ¢�4//7' S�S�/ZOZ-�� /�� /�DD��/��/ilp ©r FeeRec: <br /> 00¢' QxCK- 9/!ol B ✓ 4 Check#: I <br /> o ad1W44m4� eXDa14SlovA (180 e.d/0 .1 <br /> wit 5 cclov' 7'v <br /> ate of staff site visit: 9 Z5 g ZS� Initials of site ff: / <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ✓� ZO <br /> E r 3 <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF m ((��� <br /> G a7 ." '� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 C <br /> Burnett County,WI Land Use Application—Rev 04/2024 -3 <br /> I D <br />