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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> d <br /> Dwell ing/PrincipaI Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C7 p� <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 rC! <br /> Driveways/&Campground Structures $125 X WI State Statute 59.692(ly)Structures d' o <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. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner's Name: t J AA cl tk o <br /> Property Owner's Mailing Address: 3 lilt(i' L✓���ot.r L Sly �Y 1144 <br /> �S10 <br /> j� n City State Zip lJ <br /> Property Site Address: �/Ut'� P4"d tAn Q u cc d` `Jq-I hi ��T <br /> Contact's Telephone Number: '� <br /> p l�l��� lt��-�'7v - -;�� 1 a. <br /> 'I d <br /> Contact's Email: �.)[�q�(/l /�.w(,�d4t't� <br /> **If staff has a question about this application,you will 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 00 <br /> 5' <br /> Legal Description of Property: PIo,l .3 d <br /> Section#: Town#: Y U ti N Range W Town of- U ArK1 A,1e <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): <br /> Proposed Use of Structure/Addition: Pot+Cc) <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: &[�alcf' kadi147- Sewer Installer: O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> rvllpw ���wi��rlrrs S�oreland �S-fo�u�i��Pf�Serva � jreern�► s <br /> Fee Rec: <br /> z Check#: .3 <br /> r <br /> a� <br /> Date of staff site visit: 20 S Initials of site visit staff: <br /> n ,� <br /> APPROVED BY LAND SERVICES OFFICIAL: (7Zd�Y�DATE: <br /> 23 5 m co C= <br /> z.3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 oCD a <br /> [� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 31< <br /> CD <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />