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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> Applicant Complete All Sections Below This Line ' c uNi <br /> Permit Types and FeesiPlease,check appropriate boxes) ° <br /> C7 <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk I iBunkhouse $250 <br /> Driveways/&Campground Structures $125 1 jW1 State Statute 59.692(1v)Structures $350 0 1 <br /> Filling/Grading $150 1 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 1 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. <br /> z ` <br /> Property Owner's Name: D&A 1 ct 4 1.1(l L1 J o In rl.)o n <br /> p o <br /> Property Owner's Mailing Address: 5J �3 17 of', t1v-c, 5 g A er Sc L)1 5 L4 o Ls <br /> c� City State Zip ' d <br /> Property Site Address: p-I l 5 1T T �(��C 5 i W p2 o <br /> Contact's Telephone Number: 2�QIZ- c62- o � <br /> C7 <br /> Contact's Email: IRS-0 iU t5 5 n Z CD (�M A <br /> h <br /> **If staff has a question about this application, you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov S <br /> 5" <br /> Legal Description of Property: 5 o Str m a G.j e d p <br /> Section#:�_Town#: `S_N Range#:_� 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 /> 0 <br /> Tax ID#(1-5 digit number; found on tax statement): -Proposed Use of Structure/Addition: Hoyyu- I CA-bi n {fie_ t r A b r; 0&f-C A <br /> J L <br /> Anticipated Start Date: L1i� 17 , LO L7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> CN <br /> Building Contractor:}Ityl(,Cie LLG Sewer Installer: pre U 10a S (?W Aex- <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: z <br /> 0 <br /> m <br /> Fee Rec: <br /> ° Check#:rn <br /> r <br /> rn <br /> c— <br /> Date of staff site visit:tZl�_rp/ 5 Initials of site visit staff a <br /> �- 0 m cri G <br /> APPROVED BY LAND SERVICES OFFICIAL: l DATE: 7�2 S�Zo ZS <br /> UPON APPROVAL: APPL ANTiV UST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> CD <br /> Pagel of 5 <br /> Burnett County, WI Land Use Application —Rev 11/2024 <br />