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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This LineCD <br /> ' N <br /> Permit Types and FeestPlease,check appropriate boxes) ° <br /> d <br /> Dwelling/Principal Structure $300 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.) $150 Addition/Alteration to Accessory Structure Off .$- <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> M ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ` <br /> s(permit acquireTaectr i�as ra ptotree�iestenorms eOTE: ft c perm e <br /> b <br /> *Communication Towers,camping Permits&Signs require a different application orm;see correspon tng application,and fees. C' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. or <br /> o \ <br /> Property Owner's Name: "i`: i en !Qa O Al�, ' q o <br /> 0 <br /> Property Owner's Mailing Address: S2L{ ta4" Pk- 2. � � <br /> 0 n <br /> City State Zip <br /> Property Site Address: r loJ �i41; S ( Lt�'L+rsi ^1 o y <br /> N <br /> Contact's Telephone Number:�,� j �S " .S"3 Z G7 R °' <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 /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov "Q <br /> 5' <br /> as <br /> Legal Description of Property: d <br /> Section#: Town Town#: N Range#:k 1,� W Town of: - LU s. „S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): �,: `Z� i✓ w v <br /> C7 <br /> Proposed Use of Structure/Addition: 6 !� .� <br /> Anticipated Start Date: Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> s � � <br /> Building Contractor: 4� f Sewer Installer: y _ N <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 /> v <br /> T <br /> Q OttT OF 1-6tc Zto RFr < l)1 <br /> CA <br /> O2 F{vtvo2 ?Rt09 WVrCAA,P SCl-94CC5 OF- PREOWS LV?. <br /> a m <br /> A10 ExP0,IVSIDiv -MwARt� Q)ETt�N'D RLtoWE-D- -� FeeRec: " <br /> ° <br /> Q L5EPTK EUAL-4rADA/ 71) Ee eoauPccren Check#: <br /> i3y Il�I�2oZ5, z <br /> 5O pRt\j4 Tv ae RewoVC0 oiz r"URiwTrEp BY 9�1�Zo25. <br /> v � <br /> Date of staff site visit: &/fol z5 Initials of site visit staff: 1X i <br /> APPROVED BY LAND SERVICES OFFICIAL: 4-„ A J DATE: lc�zo'2-.7_5 m c° <br /> ;2 - <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o � M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 �, <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />