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, <br /> LAND USE PERMIT APPLICATION -Burnett County, WI & cl <br /> r <br /> a � <br /> Applicant Complete All Sections Below This Line ' vNi <br /> Permit Types and FeestP/ease,check appropriate boxes) ° <br /> C7 1� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v; U <br /> �'\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ 0 <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 /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 � v <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. C>4 <br /> o FQ <br /> Property Owner's Name: p4z'r STo ✓c =' N <br /> n N <br /> Property Owner's Mailing Address: !3S } A/r= / �/� Oci✓cam l�'L Sy�a l w. N <br /> City State Zip -,(j 4 N <br /> Property Site Address: )3S l iAU,✓E !Dn-1✓6 o w <br /> Contact's Telephone Number: &/Z—Z70 16) a <br /> C7 <br /> Contact's Email: �4 65&S TD✓� �- ��/T/j?i¢/L �' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °Q <br /> Legal Description of Property:LOT I CW VT-7 P 2 I S DU y 5$-j9 ? N <br /> Section#: Town#: 4/) N Range#: 0 W Town of: SL6 1 j <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): 3-Q- vJ <br /> _ d <br /> Proposed Use of Structure/Addition: /jCJ�1JjK�fDr/Sc �N� �9�V� �J.1 <br /> Anticipated Start Date: G - "Z-S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (� <br /> s <br /> Building Contractor: Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> m <br /> o l l ow a,(,� GcXt�i fi�S ( V a�i a►�ce , V V- 2y-32 < <br /> CA <br /> 0,(9� rr 1 �''^����/ L r- - / '- m <br /> Gx is- a J ���X I�p , Sh cj l S �0T a&t-t 4o to C( �unkJ1 wl-e r See' � Fee Rec: <br /> � rii4 2 ' C�UeJ'-c! vk Check#: <br /> -to aSke d. 1 X CK 91,35 <br /> � e ;S jVCC0 d �u+ -E Pit �1a i n based o� Co f ��n�S m <br /> a►0 y <br /> rr <br /> v <br /> Date of staff site visit: s f 514025 Initials of site visit staff:-�l7i t��l <br /> !1 u IJ <br /> APPROVED BY LAND SERVICES OFFICIAL�� DATE: s Z`� ZeILS °0 n <br /> 1 <br /> cm <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF M <br /> 0 -%j M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />