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- em cci c J c—p pt�eD veti <br /> LAND USE PERMIT APPLICATION -Burnett County WI r <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees�P/ease,check appropriate boxes) a 1 <br /> Dwelling/Principal Structure $3001 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <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 /> C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk 113unkhouse $250 <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(ly)Structures $350 r <br /> Filling/Grading $150 113oathouse $500 <br /> w <br /> Soar Panes Stand alone or roof mounted) $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. S <br /> "� z <br /> Property Owner's Name: ` a r W) D n N <br /> Property Owner's Mailing Address: G�hlrl <br /> L n H M 5-#up3 <br /> 3bO 1��� / City State Zip <br /> Property Site Address: ( G( �G/'/?�i� W/ 7O F „ < N <br /> Contact's Telephone Number: ��s" CD <br /> Contact's Email: � <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> b <br /> legible and your email provider will accept emails from the following address: @BurnettCo tyWI.gov <br /> Legal Description of Property:SC A/V Cx � PFsC, <br /> d <br /> Section#: _Town#:�N Range#:—�� W Town o£ 0ak14lif <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> Tax ID#(1-5 digit number; found on tax statement): 32 f0 w ,� 0 <br /> Proposed Use of Structure/Addition: A611t, — <br /> Anticipated Start Date: JS)L (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) tN <br /> Building Contractor: �� � rarjx� Sewer Installer: l0 P4o5foyl 4 W y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z ;V <br /> y <br /> D <br /> m <br /> t V QtJ,, I Z b 1,,td I- u N <br /> n LTYIS m <br /> n.C4 + <br /> y <br /> Fee Rec: <br /> °z Check#: <br /> m <br /> v U <br /> Date of staff site visit: Initials of site visit staff-11-3GCL <br /> y <br /> APPROVED BY LAND SERVICES OFFICIAL. a DATE: 5 2U2S m C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2D o ] <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 �0� <br />