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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> N <br /> Applicant Complete All Sections Below This Line p* <br /> Permit Types and Fees(Please,check appropriate boxes) 740 a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CP <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 S Z- p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 • 1 op <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ) <br /> r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � _ A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 L <br /> Filling/Grading $150 Boathouse $500 l <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. `ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> r i. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P. v <br /> Z <br /> ,77 0 <br /> Property Owner's Name: A CO�'�- ��C' c o le o (w� 1 <br /> Property Owner's Mailing Address: 9,'L 0 Lie.I tk7 c77. /(,w-4- .c,e Li ,i''U Sf05- n ,fir <br /> Z 2 SSI R.A. City State Zip E v <br /> Property Site Address: 2`s(55-1 - C 11�v Ir 1��n �i✓r7 i.i ' S 1 C3° \ o y : <br /> 2 ���2 � 5-0r <br /> C a <br /> Contact's Telephone Number: r ^ �1( �7—so -"5----6,fd( i ��, d <br /> f.� <br /> Contact's Email: r+c) <br /> **If staff has a question about thigapplication,you will be contacted videmail. Make sure your email address is N b <br /> legible and your email provider will accept emails from theeJfollowing address:' @BurnettCountyWI.gov o• °Q <br /> Legal Description of Property: Pe.t' cnDAIS /'-i✓4C 6 '''i`5 L`�r 3-` d <br /> Section#: O--A" Town#: 'f 0 N Range#: I Cs, W Town of: Oa,k l a-xS.- 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* rn <br /> H H <br /> Tax ID#(1-5 digit number;found on tax sttaatement): 1 Al &C, 7r, . ) i ; <br /> Proposed Use of Structure/ ddition: /V-4" f 5 <br /> Anticipated Start Date: / 4I y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: r -'c(c.� t ') Sewer Installer: /4.1A- cel <br /> �� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY s <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> z <br /> S <br /> w <br /> . <br /> Fee Rec: /2.5;�- <br /> g Check#: cc21( <br /> IJDate of staff site visit: ` f/"�z/ Ini ials sit ' taff: //7f— <br /> / i 0 3 121 <br /> NU <br /> U <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: fi.4.5.../"ZeZ R.5 0 <br /> g3 CD <br /> UPON APPROVAL: APP CANT MUST POST COPY OF ? ' o SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> FEI <br /> Page 1 of 5 M J) <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />