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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> . P. <br /> Applicant Complete All Sections Below This Line c uNl <br /> 10. <br /> Permit Types and Feeselease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 `f 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 . i <br /> Accessory Structure(Commercial/Industrial).$200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < .-, <br /> Driveways/&Campground Structures .$125 WI State Statute 59.692(1v)Structures $350 CI'\ <br /> Filling/Grading $150, Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 6 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `-$ <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r "' <br /> z • <br /> Property Owner's Name: / t, Jr\4 r? I POI(I . A Ye J I''t' o i';')Property Owner's Mailing Address: S //< 7 Ca G 0 u o.4Y kck C- l k,11 B e y CO t .5 gP36 1 n N ,� <br /> City State Zip 4 N <br /> Property Site Address: ,,_ Cc..vv't -- . c <br /> Contact's Telephone Number: 7� 3 4 3 ' 4 a.(O C a go., <br /> C7 "b <br /> �/ AR c <br /> Contact's Email: et'� t l`lax � 1,�2c.qq-(�r> P 4� u v�c;� y . cow.... /.._. vth�fC'y'�-'ia�w <br /> **If staff has a question about this'applieation,you-"4vill be contacted via email. Make sure your email addresa'sv b `� <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov (Kr <br /> � <br /> Legal Description of Property: LOT `-( L Sk,k, S j :A QL ( (a 11I 5- . = <br /> Section#: I Town#: �o N Range#: � -� ,T ��W Town of: � �S�vt <br /> �' <br /> �1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ti <br /> .-3 *-3Tax ID#(1-5 digit number; found on tax statement): 3 C. -Al c, <br /> Proposed Use of Structure/Addition: E-I v vti.v H <br /> Anticipated Start Date: /0/ ( / ? ®;" -j (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z t 1 <br /> - <br /> Building Contractor: /t) �0 4 P J:-4"r b.-` Sewer Installer: y t, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t <br /> z o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c <br /> Q ii4EET DIU.- Set& c w S tz <br /> ` Ul <br /> Q IxZELLIAR, nor 'rd �nc.Eeo 3 BeDe00NA5 i2 dAgN.30952 M <br /> OC.o..4r4c.1— OCX.. 112N,TIED Dw Cc.u4)6- Cot,€, INS?EMIL._ , ,R Fee Rec:ar 4' <br /> ° Check#: <br /> ,v cC eSS.�K�E 1 15 r <br /> r <br /> z <br /> Date of staff site visit: 4/ro fr Initials of site visit staff: DG i L�.J E <br /> APPROVED BY LAND SERVICES OFFICIAL: j .6 I DATE: 9/3al 2o2_5- a <br /> 11gIl n 1 c? co <br /> CNJ w <br /> UPON APPROVAL: APPLICANT' UST POST COPY OFF <br /> t,t in to <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ;1 `'`a tt <br /> Page 1 of 5 1 <br /> Burnett County, WI Land Use Application—Rev 11/2024 / <br />