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L Ok ai Nips y <br /> CA .ti r <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' VI ci <br /> CD 1 <br /> Permit Types and Fees(Please,check appropriate boxes)' a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..i1 <br /> / ` Accessory Structure(Garage he etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> 1111 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ow <br /> 0„ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °r» k <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. t <br /> ro r <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. o <br /> P <br /> Property Owner's Name: IM a✓ \( a e-}LI S `-s e S t K $ f 8 f,11 l <br /> a. <br /> Property Owner's Mailing Address: 1 0 2- 0 y to h Coµ r ry1 0,1,.a-o-v►€d c rn Al 5 S I I S 77. J <br /> ,�� City State Zip ° 4 1 <br /> Property Site Address: 2-QQW� 5e Jok„son LAke. gel W W.ebsl-er . C <br /> s4�8 c 3 1 <br /> Contact's Telephone Number: I - 1-O ( - ( I -1 3 ad t <br /> v <br /> ' <br /> Contact's Email: L S K cA,vt es ex, a. iM ct, i I . Co y1n `°. <br /> **If staff has a question about this application,Nu will be contacted via email. Make sure your email address is N ro 0) <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov ° tl°s. N <br /> Legal Description of Property: S e e, a-t 4 a C.t e d o w <br /> Section#: 2.3 Town#: Si 0 N Range#: { 6 W Town of: O a-K. ( a n. A <br /> -D -0 <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): 3-2,3 W <br /> Proposed Use of Structure/Addition: 5 E'.ci .� <br /> Anticipated Start Date: I 0 - II+ -- 2.$ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> Building Contractor:Q 14. 4 ;c-l.e--e <br /> !2 Y 7(d.35 Sewer Installer: F W J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Z --� <br /> © NAEE7 All SETS/lc-vs x b <br /> • <br /> /l.Cs[ Ta BE dSeD FoGL Hvuc09N NH61T9TIDrl1 <br /> Fee Rec: <br /> tom•c <br /> a Check#: )2.375 <br /> n <br /> rn <br /> I o <br /> Date of staff site visit: 9/30 IZS Initials of site visit staff: ' 0 <br /> a <br /> WO <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9/.30'2025 I mr m c° <br /> < 3 <br /> UPON APB ''. L TAN T •,-,, 0 0 N <br /> 4 o N O <br /> CD c IV <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q <br /> Page l of 5 M <br /> Burnett County, WI Land Use Application-Rev 11/2024 JJ <br />