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LAND USE PERMIT APPLICATION -Burnett County, W1 a <br /> Applicant Complete All Sections Below This Line c cn <br /> Permit Types and Fees�Please,check appropriate boxes); <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to DwellingJPrincipalstructure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.); $dfi0 Addition/Alteration to Accessory Structure $150 \�\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 Q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 1 IWI State Statute 59.692(ly)Structures $350 <br /> o rt <br /> Filling/Grading $150 1 IBoathouse $500 1 <br /> Solar Panels Stand alone or roof mounted 150 1 jPermit 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 /> Ic b <br /> o Tnnmtvf+on owers, amptng ermits&Signs require a different application form;see correspon tng app ication,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: -jOne QrnrS l<e L ITI <br /> 0 <br /> 0 <br /> Property Owner's Mailing Address: )AP`7' eC er /7?U,-n7k%n 6141d, rlt't' dga 77 S � <br /> -3108 City State Zip 7 <br /> Property Site Address: 67Q IC MY. J 5 d to&u ra W-K J`l`i'3 O <br /> Contact's Telephone Number: 70 1- <br /> Contact's Email: �./CEi?e cx.Ic we-I(oi q rn c2 i 0 m <br /> **If staff has a question about this applicat on,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> SEe o5 Tn KI Ry r5 dat of. <br /> f e5M W H1F 17H Va7 P 157 (Sep 5 <br /> Legal Description of Property: sW Sec $ N W N µ1) # H 5 70 3 b t7 <br /> Section#: C 5 Town#: N Range#: i 5 W Town of: 6L i 55 I-13 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7'p Cn <br /> Tax ID#(1-5 digit number;found on tax statement): 3 J a l 5 a d <br /> Proposed Use of Structure/Addition: 6-ko age- 5heC( a <br /> Anticipated Start Date: —7-"e &i 9 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) \ <br /> Building Contractor: A//� �/{��i'C> Sewer Installer: A✓� (//� P__ 1 y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m � <br /> z N N <br /> THIS PERMIT IS SUBJECT TO ALL C/-ON)I)I/TIO S LISTED BELOW: o X <br /> l /Vof 77a be- USPa 4r^ Aw ulOKA 41a�/TA ���• <br /> { Su rp gw'r'►re�.9 a r�ec5 c%red �► �ZD ) QH� <br /> Fee Rec: � <br /> fI1,5 /S or, Gl �TT�" —�� - C JP z Check#:�� <br /> Date of staff site visit: cP S Z-r Initials of site visit s W B U u <br /> lD ZD _m r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: `- <br /> UPON APPROVAL: APPLIC T MUST POST COPY OF P D <br /> SIGNET) PERMIT APPLICATION IN PLAIN SIGHT (D <br /> Page 1 of 5 ,:- <br /> Burnett County,WI Land Use Application-Rev 11/2024 <br />