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��, C� CDr <br /> LAND USE PERMIT APPLICATIUV Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line I�?Q <br /> CD <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 (�9D <br /> Commercial/Industrial Structure $300rAddition/Alteration <br /> on/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150on/Alteration to Accessory Structure $150W� <br /> Accessory Structure(Commercial/Industrial) $200 to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $250 <br /> Driveways/&Campground Structures $125te Statute 59.692(1v)Structures $350Filling/Grading $150ous $500 <br /> Solar Panels(Stand alone or roof mounted) $150 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 /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. " <br /> z <br /> ° <br /> Property Owner's Name: W I L 4.f 1W 1.itG t#A>kg- <br /> 8 <br /> a , <br /> Property Owner's Mailing Address: 611 L CMAC M. G� a L• �4� N <br /> City State Zip o <br /> Property Site Address: C►`'( 71 ly q. W"r S y 3 Z o <br /> Contact's Telephone Number: 2 �;7 y- 93a O <br /> C7 <br /> Contact's Email: ,U/Me r,&ar y gl1,p • (moo�I <br /> **If staff has a question about this application,otfwill be contacted via email. Make sure your email address is N ° <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °. °0 0 <br /> l.0} 2 CSWi 5J(g3 V61 Zq PZ reyr-ctQQ QS Doc 4?�8"(o�l(4 taK w N <br /> Legal Description of Property: ) d <br /> Section#: _Town#: 40 N Range#:JL <br /> J_W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �' <br /> o ° � <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: J <br /> Anticipated Start Date: Pt CA►2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> cn <br /> Building Contractor: Ai Sewer Installer: ° N <br /> co <br /> 0. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: > <br /> Q rH EQ'T 4 LL SC T-BA CX-5' <br /> ZO nbT T'p SIC IUEb t'O% NUm4n1 ygDtrATtOnJ y <br /> Fot cow t REArEp D Fee Rec: co <br /> ° Check#:1561 <br /> r� <br /> o r- <br /> Date of staff site visit: 31z7S Initials of site visit staff: acn <br /> c <br /> CD n <br /> APPROVED BY LAND SERVICES OFFICIAL: t DATE: �123'zo25 � "4 <br /> m .fD— N <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> CD a C C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> Page I of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />