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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> 7. , <br /> Applicant.Complete All Sections Below This Line E ;n <br /> a _ [ <br /> Permit Types and Fees(Please,check appropriate boxes) C7 B <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> IX Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 oQ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> • <br /> Filling/Grading $150 Boathouse $500 cn - <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P. <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. a ... <br /> z C <br /> Property Owner's Name: /}yl der s// W I Gk(UYt Gi �j L/ o N , <br /> Property Owner's Mailing Address: IOU�o Pe�sot Ill ebckr W: £Yr?3 y o <br /> /' t./ ',` City State Zip 4 i <br /> Property Site Address: 6° r' P� d� Lf W e.�S��' V�+x �`l3 Z. o y <br /> Contact's Telephone Number: 7 t J 413 I 0/kr 3 a <br /> 1 0 C7 <br /> Contact's Email: 111 eur 1'1-7 141 66 e.�'4„,,t l' ,„,n <br /> CD <br /> **If staff has a question about this application,yoKwill be contacted via email. Make sure your email address is N b O <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov °o <br /> Legal Description of Property: 1-- ls <br /> 0 f 1 'st'�'1 3 5 V l 1 P2O5- d o <br /> Section#: 2.ti Town#: 3 q N Range#: /6 W Town of: ileew 0-4 (i. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c4 <br /> Tax ID#(1-5 digit number;found on tax statement): `I g3 7 W a <br /> o <br /> /� <br /> Proposed Use of Structure/Addition: Ca ell /'OY`t -- <br /> Anticipated Start Date: /0-27— ZS (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 -- W 1 _ <br /> � m <br /> Building Contractor: Sewer Installer: m k,J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONE rn z Z J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d Z <br /> 0 Y\EE? ALL SE.1 EACILS rn <br /> 6. <br /> d /vat 10 13t DSED FIR Hum4k2 y<181TATION A <br /> a <br /> y <br /> Fee Rec:/5Qm <br /> c' Check#: /c' <br /> Er <br /> et I <br /> Date of staff site visit: \OVA Initials of site visit staff: bti a <br /> APPROVED BY LAND SERVICES OFFICIAL: I DATE: /OlzB f Zo2S co co CD . <br /> 0. <br /> GNED PERMIT APPLICATION IN PLAIN SIGHT 0 c <br /> Page 1of5 <br /> Burnett County, WI Land Use Application —Rev 11/2024 J� <br />