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LAND USE PERMIT APPLICATION — Burnett County, WI g b <br /> Applicant Complete All Sections Below This Line 6' �! <br /> Permit Types and Fees(Please,check appropriate boxes) c <br /> cb <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CDd <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 1 <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 c 1 E., <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> 1 • <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ti <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. <br /> Q z <br /> Property Owner's Name: GAA 'I w. Pt Fa tr../ o '= N <br /> o 0 <br /> 0 04 <br /> Property Owner's Mailing Address: .277 2 .l ��,,,A i er4 L'," �ea1 TLt 4-9/ i <br /> City State Zip E <br /> Property Site Address: 7 7 0? -5 i.-r r2f s r C <br /> N <br /> Contact's Telephone Number: 7/S= 021 .2. - Y 3 9 3 — 2. <br /> Contact's Email: �� 44..1.✓ A./ewQi/ Qd <br /> **If staff has a quegrtioti abet this application,you will be contacted via email. Make sure your email address is N ,e <br /> o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov c CJO_ Q <br /> Legal Description of Property: Led St C E1,i V 1 7 f/ a o <br /> Section#: 7 Town#: 7 O N Range#: I£ ' W Town of: OA ti v A .0 N <br /> 2 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> Tax ID#(1-5 digit number;found on tax statement): J3 7 / W J i o <br /> Proposed Use of Structure/Addition: C A/C.A 5 E -i W <br /> Anticipated Start Date: 1I- /O` .2.. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) J <br /> .-C <br /> Building Contractor: Sewer Installer: ' 0 2 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 75 <br /> D., I Nl o+ 40 6e U ta- ti <br /> !Fee Rec: 56C9 <br /> Lund uu rcorti+ Ii i2I31 uQ5 Check#:L�'1L <br /> DIN -{-yutt-kyes putt-- I Do s -4 rvekct aj <br /> I <br /> yU V�7 <br /> Date of staff site visit: 1 )jo/2ol Initi is of ite visit staff: T�f p Z. <br /> APPROVED BY LAND SERVICES OFFICIAL: CIL) DATE: ////Z5 CD CD c <br /> 0 m < <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o L <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 _" <br /> Burnett County, WI Land Use Application —Rev 11/2024 [ %J <br />