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Cn <br /> LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line t� <br /> Permit Types and FeestPlease,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .J <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 /> �j <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 /> 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. Q <br /> z <br /> 0 <br /> Property Owner's Name: 1. S�5 o N � <br /> a 1 <br /> Property Owner's Mailing Address: In L .-t OCA6 f <br /> City State Zi ° <br /> Property Site Address: SG ►L SyQ3 J o <br /> CD <br /> Contact's Telephone Number: a <br /> N d <br /> Contact's Email: " / -AG <br /> **If staff has a question about this appli n,you will be contacted via email. Make sure your email address is `l <br /> legible and your email provider will accept eemaails from the following address: @BumettCountyWI.gov � °° •i <br /> Legal Description of Property: �+ 2- / -6`1 l80) 'i V 6 v 313 Rt av D6 C, d U a <br /> Section#: Town#:�N Range#:�r_W Town of: �j�,,,i . � 0 V' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system p,\operty page.* JQ1 <br /> N o <br /> Tax ID#(1-5 digit number;found on tax statement): Z W r <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: J (Home/Cabin;Commercial Busin ;Bedroom;Deck;etc.) <br /> 4- <br /> BuildingContractor: <br /> x � <br /> (?'( L5 Sewer Installer: y � CAL <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m u N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> OI miner .4LL Se-rIbACM-7 . 50,AK ► -RRA4 Tb ac ?ID Feer Fin PA Dg4mjFIMLO. <br /> 0 n/o-r "ILA aC uset, Fora, HV'WAA1 NR6irogTIVV. nn <br /> © TSgaP 5t+�o ro 8F f3E►kou�D oe YERcuttr£D S7 811T/ZoZ5. 4usT <br /> N(gET Fee Rec:300.O0 <br /> 16 FOOT JIVE -PPA9C(4r/ LINE SC78ACk. n <br /> z Check#: y o (o <br /> z <br /> r <br /> r— UUU <br /> Date of staff site visit: SI22l2s�7/Zi�23 Initials of site visit staff: �$ n <br /> CnM <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: TLx1(Z0Z5- CD � "c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF -coo o ry <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �t <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />