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LAND USE PERMIT APPLICATION — Burnett County, WI Q (71 <br /> Applicant Complete All Sections Below This LineCD <br /> a. <br /> Permit Types and FeesfPlease,check appropriate boxes) a d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 1 Addition/Alteration to Commercial/Industrial Structure $200 "� p <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 IBunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl 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 /> 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. r <br /> ° z , <br /> ° <br /> Property Owner's Name: ow EMc "o N I <br /> Property Owner's Mailing Address: b OVA r' E� Mjj S5 123 rQ <br /> C) T <br /> City State Zip <br /> Property Site Address: ,_1 g 891a 3d o y <br /> Contact's Telephone Number: (0 S <br /> Contact's Email: C ra: . SN w"of 40% ✓NQ• / C <br /> **If staff has a question a out this application,you wilfbe contacted via email. Make sure your email address is N 10 W <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 2. °O <br /> Q OQ <br /> Q <br /> Legal Description of Property: L.O� �.. C..sAA V Lt 1 4 <br /> Section#:-_Town#: 14 D N Range#: _W Town of- 71— V-s Dn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �' <br /> C7 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 1030 <br /> ` -- <br /> Proposed Use of Structure/A``ddlition:��PIa�L QX�S't�v.4 'boa b"Se< <br /> Anticipated Start Date: C)L'To�r 29 Zy (Home/Cabm;Co ercial Business;Bedroom;Deck;etc.) (� <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> SmAkmAse, 4t �X fe-f (kcl ,k VA <br /> ZO�Cl h nod [12 o td -Gsr �t�rn o-►1 �l I� Fee Rec: <br /> Check#: <br /> © �'o�l�w -��cxQl c�►� elev Q9 re e,►-r�e.n+- <br /> Date of staff site visit: //Z 3 ZQZ—f Initials of site visit staff: a <br /> APPROVED BY LAND SERVICES OFFICIAL- .f.,/ l// �'y DATE: 1 ? 2W' ro m co <br /> T MUST POST COPY OF = <br /> UPON APPROVAL: APPLICAN -00 <br /> FM <br /> CM <br /> 4 <br /> SIGNED ��.� ::.., i-T TAT T/I--==-- m- =-T TT 1 T7►T (1T I^1TTT -0 = n� V <br /> 1 �� _i 111 ►J1 V 11 N r <br /> Page 1 of 5 � f�U <br /> Burnett County, WI Land Use Application—Rev 04/2024 ��_� <br />