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LAND USE PERMIT APPLICATION— Burnett County, WI ct g <br /> Applicant Complete All Sections Below This Line 5• <br /> Permit Types and FeesPlease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1' p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 , 0 <br /> x Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> 1 <br /> Filling/Grading $150 Boathouse $500cn <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 /> *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. g' <br /> z <br /> 0 <br /> Property Owner's Name: M t Gr{A(.L- t. 4isC o N % <br /> o <br /> a <br /> Property Owner's Mailing Address:L`i 3In4 ccA-.-I'Ic Vt Ev.) Li'), sPuoA g. .,J 5 iI'a•% t n N3 <br /> = <br /> City State Zip E N <br /> Property Site Address: SA t^E o N <br /> Contact's Telephone Number: 74 15 -A 30t - 2A 140 a <br /> d <br /> Contact's Email: Nl t ICE-, n IL d 0 X )1C f . (A t.,1 CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov act <br /> Legal Description of Property: Sv'oat S E (I h rAA Lam 571 <br /> Section#: 0 c'. Town#: 3e N Range#: I ti W Town of: 31E t"N('i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* D , v' <br /> _ i <br /> iv <br /> Tax ID#(1-5 digit number; found on tax statement): 3/La© N <br /> d <br /> Proposed Use of Structure/Addition: L 7;.E.t-)=t 0t3 0 t= EX`rit&I'=' prHtg-S TO aLti 'o , <br /> Anticipated Start Date: 30=1 ( S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,t; <br /> Building Contractor: S t c c Sewer Installer: is-) I r! <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6 -! <br /> z <br /> 0 SIa r <br /> b --D -P,x c etc/ 5c <br /> Crl <br /> cn <br /> Fee Rec: / 2— <br /> 3, Check#: ecv,, <br /> z <br /> trf <br /> Date of staff site visit: Lf/5/2024 Initials of site vis' staff:` <1 +61L ,W (1(J <br /> APPROVED BY LAND SERVICES OFFICIAL 1ATE: (Q/L /z 2 / 0 CD <br /> `� — <br /> ci)m ^• hit <br /> L <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m= N o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 . f <br /> Page l of 5 LL JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />