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LA <br /> LAND USE PLRM111T APPLICATION-Burnett +Count-Y W1 <br /> o. <br /> Applicant Complete All Sections Below T his 1.1ne � I CD C�1 <br /> Permit Types and FeesiPlease,check appropriate boxes) <br /> a <br /> Dwelling/Principal Structure $300 1 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> lnmmorcial/induicjrial Ctn rturo $300 Addition/Alteration to Commercial/Industrial Structure $200 I G <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 w <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> 1: /r` el r- n c`r I0 <br /> Fllung{vraading 71vv Boathouse $500 <br /> Solar Panels(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 /> b <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. I� z <br /> 0 <br /> Property Owner's Name: 01X LIS'TC = M S 1-4 Itr =' <br /> pR-opt^2T1 E5, «� g I <br /> Property Owner's Mailing Address: 1551 Roo#Jitj LAKE Po. S W1 54901 c� N <br /> Citv State Zip IF <br /> Property Site Address: 'U>661 IUVV,TP-Rq LAKE Vi A?L SDoow)�'YL t�l z c N <br /> t <br /> Contact's Telephone Number: 414 - 55 z, - 1 9 <br /> f tiv <br /> Contact's Email: S'T�V CE? T N ER M O MA i L • CO✓t'1 <br /> **If staffhas a question about this application,you will be contacted via 6maif. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °Q <br /> J-egal Lvsv/iYuvu vi i lVPCILy. L WT �1 C5'•1 1*3 P SO-1 l GOV L.17T Z) <br /> Section#: (?i Town#: L10 N Range#: W W Town of: SCQTT <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Cn <br /> kP — o + <br /> Tax ID#(1-5 digit number;found on tax statement): -7 Cl(,0 N I d <br /> Proposed Use of Structure/Addition: CA Pni id ti <br /> Anticipated Start DatePx ech ased asaCabiWomelCabin;Commercial Business;Bedroom;Deck;etc.) — + '� <br /> Building Contractor: Sewer Installer: f O <br /> �' IO <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONIMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> bAou n - Y c Ltd bedrD�ns �e�' 1 22(eg Z I� I ,dv <br /> / n Fee Rec: � <br /> 0WD(k � Vb� lns f-I( ,y 61j+� ptr(n4 w PUIX11"I. Check#: y <br /> o <br /> Date of staff site visit: 5 f OZS Initials of sit visit staff: 7 Cn�C 4 n <br /> CD a <br /> CW 3 �U <br /> APPROVED BY LAND SERVICES OFFICIA DATE: 3 � R? <br /> m <br /> Cn <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD G� <br /> Pagel of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />