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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 0 6" <br /> Permit Types and Feeselease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m`% <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) '$1501 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 r <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° r(l�J <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" , <br /> 0 <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. `q Lt <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. a <br /> ir <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 t <br /> z 1 <br /> 0 <br /> Property Owner's Name: $4-eve_ C�e en e. — 0.() t <br /> I-L 8 911 J4 ti'1 i o n Al r^'tJt--rc G,.�., S-Yy37 `, .-1 <br /> Property Owner's Mailing Address: . n W <br /> City State Zip E <br /> Property Site Address: 5 4-14%ft A-5 A6 u v r< <br /> 0 y <br /> N <br /> c <br /> Contact's Telephone Number: 7(s- L 2 2 -7 k l ) <br /> N d <br /> Contact's Email: 5 vvi.1 k SO C'1ct k 0 c c'•es :: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is il <br /> legible and your email provider will accept emails from the following address: @BumettCountyWl.gov 0 °O W <br /> crq <br /> Legal Description of Property:LOT 1 CS IN1 V 2 PIN 1 ([N G OU LOT 46 d -� <br /> Section#: S Town#: 3 g N Range#: 1 6 W Town of: Le, ((t ffe_ 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* - E <br /> o ,-3 <br /> Tax ID#(1-5 digit number;found on tax statement): (O /7 VI <br /> Proposed Use of Structure/Addition: 6w''-3e, , C7 <br /> Anticipated Start Date: h'1 Z 0 1-41 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) —z w a1 —I <br /> Building Contractor: "") (t 'r Sewer Installer: Nr� b- <br /> o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> CPZ4- a�,tst- �s N <br /> VI 01\\p-k -� be Used -Eon �u,n�a►� �ubl �� m <br /> N C <br /> 4-1 Fee Rec: /5-OLP <br /> ( I C.L1 Gl ✓� b y 1`15/2y 2 Check#: //05i) <br /> CJ � �1 iC�S `r0 SQCc.�fe� l�:t-lam G� - ,< <br /> (DI K bk) w01kW AID - lake needs G Land Use flermii- by 11151zo2y <br /> y <br /> /, o l J <br /> Date of staff site visit: 6/3OIloZ`( Initials of site visit staff: d-6L aei- hill <br /> APPROVED BY LAND SERVICES OFFICIAL:c ���'" (I -- <br /> `!���w1Mp 14^ 1e 7 DATE: lP lig J2D2'-/ f°<. n <br /> 3 -< <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a, <br /> m= ma <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ma <br /> CD [nrii <br /> Page l of 5 �� ..2) <br /> Burnett County,WI Land Use Application-Rev 04/2024 <br />