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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> r y 1J <br /> Applicant Complete All Sections Below This Line - <br /> Permit Types and Fees:(Please,check appropriate boxes) 1 — <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 cv <br /> 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- ,� <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 Z I <br /> Filling/Grading $150 Boathouse $500 w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. C-3 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ° z r.... <br /> y� o <br /> Property Owner's Name: 1i M it L ii wit (r 1 L P 04 vt II..�`` <br /> Z 2 rfIC1L 12e f/`fjew.ic W� citt3i <br /> Property Owner's Mailing Address: 1�{ ITS • <br /> City State Zip 4 <br /> Property Site Address: Sti • c <br /> Contact's Telephone Number: 1 (c ' 2 2,) ` 30 Z 3 _ o f <br /> Contact's Email: Tl by1 13( 'mot tA.✓\ l: r ax ` ' Ccron <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,ti <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov g. w Nit§ <br /> JJ • <br /> L Legal Description of Property: 60' a- I 2— q/ <br /> Section#: 3 ( Town#: 3c27 N Range#: C� W Town of: 1...ct�C =L <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c' <br /> o m <br /> Tax ID#(1-5 digit number;found on tax statement): (O t 0 E x <br /> Proposed Use of Structure/Addition: ► (` Sees o i Peyv-e.-4 1 .- <br /> Anticipated Start Date: L .c c. t ►v 1 exki (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:(4e.ki1 IN 01-,c" Sewer Installer: [Sri -1°P 6 - cn <br /> ci ; O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z N <br /> Ln <br /> — 'Fj.\ \ <br /> a <br /> Fee Rec: o2(,5- <br /> Check#:(a <br /> r <br /> z <br /> m <br /> n <br /> m , <br /> rz <br /> Date of staff site visit: ✓ / Initi of visit . <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: .r ZO $.5 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r <br /> Page 1 of 5 J @ <br /> Burnett County, WI Land Use Application—Rev 04/2024 ` <br />