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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and FeestPlease,check appropriate boxes)- ° <br /> C7 \ <br /> Dwelling/Principal Structure $3001 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 p� , <br /> G] (" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk iBunkhouse $250 <br /> !� Driveways/&Campground Structures $125 1 jWl State Statute 59.692(iv)Structures $350 <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 3 <br /> *Communication Towers, Camping Permits&Signs require a different application form,see corresponding application,and fees. fD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> z <br /> 0 <br /> Property Owner's Name: {tea u I CL <br /> 0 <br /> Property Owner's Mailing Address: 7 O / V.00, G 1 u L �J K OQ L 4 0(6- 1 w <br /> City State Zip ° <br /> Property Site Address: (a 171 L.-n ke.- c-l& PZ d c <br /> CD <br /> Contact's Telephone Number: / ! 903 ! � 70 <br /> Contact's Email: YJ n k-.,I cA P�' v(cA rA c;,c u e x!�Y\ .L <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept <br /> -+a� rn ccept emails from the following address: @BuettCountyWI.gov Q0 <br /> Legal Description of Property: L0► sm V19 PZ39 A U531)(FR SW-*) d N <br /> Section#:� Town#:_L�_N Range#: W Town of:SW1.$s <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): a�15-03 70 <br /> , <br /> ` � t � d <br /> Proposed Use of Structure/Addition: - ,CQ r2 f' Y n GU 14,+7*Yj <br /> Anticipated Start Date: MY-A Q (Home/Cabin;Co mercial Business;Bedroom;Deck;etc.) N <br /> Building Contractor: Sewer Installer: W G ~~ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 4'S ME*) �oHe4l iH le�rw+�� STR_�,3"= Izz, <br /> m <br /> a <br /> Fee Rec: <br /> Check#: //52 <br /> Date of staff site visit: Initials of s' visit r// CL <br /> m c� <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 9 ZD ZS K.5 <br /> m <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF " <br /> Ki <br /> ll <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 ' <br />