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A l <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a I <br /> .c. .. N <br /> Applicant Complete All Sections Below This Line o' c 4. <br /> Permit Types and Fees:(Please,check appropriate boxes) , d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w io <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 J <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 �I <br /> Filling/Grading $150` Boathouse $500 , <br /> rn �` <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. <br /> ro <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. k <br /> Property Owner's Name: Rp4),s,- /let dgA?2Av o tV ( n <br /> S Q e - t / J 7v,, O. <br /> Property Owner's Mailing Address: 17/� 01,4 A k'L � � 6' <br /> 4--- <br /> City State Zip E lk <br /> Property Site Address: /7/5- Q/J A eci �P vJ� w/ t y Fi1 / o y <br /> . c <br /> Contact's Telephone Number: (7/61 - gel'Y N <br /> /A // zi <br /> ..0 <br /> U <br /> Contact's Email: I keI v e r d2/Y)at h <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWLgov V b0 J <br /> Legal Description of Property: /v J J wi o e <br /> Section#: ,pG Town#: �O N Range#: /(74 W Town of: Sc o , <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v, <br /> Tax ID#(1-5 digit number; found on tax statement): 3 37 5-6 k 6 ` <br /> d <br /> Proposed Use of Structure/Addition: S tOf Sk.g• -3 e W <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C1•1 <br /> s -C -.I <br /> Building Contractor: Sewer Installer: cn (—j <br /> 0 <br /> cn <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> 0 [ t+ aUI s e,-kba . s ° `— <br /> m <br /> 2 No be ed -fir man �abi +ck-E-�� , S-b rzA9Q o,�Ly _c <br /> Oa -Io be raved Dr age 1y -Cor a reZai -fro /.2 o r a COr t yud. $, Fee Rec: /5 6�' <br /> °z Check#: f5-05-(� <br /> lase- Farm t4- 121/41 $/112ozzi r <br /> mtr <br /> 1: —� <br /> Date of staff site visit: 2/zz/202/i' Initi is of site visit staff: ACT ti—J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 2-/231ZUZy 52 i -- I in <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 °_° ind <br /> � � r <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` cm o <br /> �,‹ <br /> CD 1 Ind <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2023 Llz. JJ <br />