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� b <br /> r LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> Applicant Complete All Sections Below This Line N N <br /> Permit Types and Pees�P/eose,check appropriate boxes), <br /> Dwelling/Principal Structure Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure q$200 <br /> Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° v <br /> Driveways/&Campground Structures WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels Stand alone or roof mounted 15 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 /> ommumcaFi rs, ampmg ermits 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 /> 0 <br /> Property Owner's Name: a 6 L/k 1-, "..1 (n n q,-t o <br /> Cca��,,.yi.t P� c <br /> Property Owner's Mailing Address: (0 - st g z — (Z r) <br /> 2�969 City State Zip <br /> Property Site Address: )L� t^ �� [� Q P�iT S'6 Q (L(o o <br /> C <br /> Contact's Telephone Number: / S' ZZa S S n <br /> d <br /> Contact's Email: Y> O r1-\Gc.Yri(433) <br /> **If staff has a question about s application,you will b contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following 1address: @BumettCountyWI.gov °O <br /> Legal Description of Property: �1 a C 5M� `l5 N , Z. '5 -509 <br /> Section Town#: N Range#: W Town of: ICY f 25 to tau <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* �n <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): 3 s3 9 2— t W <br /> Proposed Use of Structure/Addition: a P-o n F 6A e,L-, S'C o P-R to £- �e_A l Lf-- W <br /> Anticipated Start Date: -,V a N e- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: n `i. W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m —O <br /> z � N <br /> TTHIIS PERMIT IS SUBJECT TO ALL C/ONDITIONS LISTED BELOW: z N --� <br /> /Vo7 7� IO C. u seal 4r A 4 MCI q'/^ <br /> qy� of <br /> � A <br /> m Fee Rec:< <br /> M <br /> z Check#: -76Q <br /> m <br /> n <br /> Date of staff site visit: Q/ZSLzQz 5- Initials of site v' ' aff: y/7nn1% m �� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z� ZOZ�� a Ff <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF Z W <br /> cD N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o <br /> a <br /> Page 1 of 5CD FU <br /> - <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />