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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c <br /> PP P a CD <br /> Permit Types and FeestPlease,check appropriate boxes) . <br /> - C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200co <br /> .. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 S <br /> F <br /> X Accessory Structure(Garage,Shed,etc.)1Po $1515 Addition/Alteration to Accessory Structure $150 n5 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 _\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 ci— <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _. <br /> NOTE:After-the-fact perm' permit ' ed after construction has begun)may cost up to three times t e normal fe <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a n orm;see corresponding application,and fees. "— <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z- <br /> Property Owner's Name: o --- 1Z-- <br /> n 0 <br /> Property Owner's Mailing Address: ass 10 12.\T _ t, sr�- � �4 <br /> (. 89 w <br /> 3 In <br /> n City State Zip <br /> Property Site Address: Xi St S 2&LT 3,-2D Z o N <br /> N <br /> Contact's Telephone Number: 419- titL`q 46 a N <br /> 111 <br /> Contact's Email: +` -ILA -l -- (trim— `% <br /> **If staff has a question abou this applicatint,you will be contacted via email. Make sure your email address is �' <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °O <br /> Legal Description of Property: (-c 4 CSiv1 45o V zs PI (Ltl i> it43274 t7 N <br /> Section#: Town#: N Range#: W Town of: Ot -kz.nc1 0 W <br /> ( <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ' <br /> ¢1`1 0 <br /> H <br /> Tax ID#(1-5 digit number;found on tax statement): 7- 020 " 2- 40 1 to- 33 --S- hO i - <br /> ©1540 d <br /> Proposed Use of Structure/Addition: PotE- F H O s <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x i t <br /> Building Contractor: Cl e t y Sewer Installer: Nj lit <br /> , = <br /> En <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY pi <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o x <br /> D Mf a au Se.-vbaisrn <br /> m <br /> 0M04-- AO 11e- �,1s.Q,d -cosr \U-M Y1 6,10i4 kt ,s-+-ar«,e to 1i <br /> > Fee Rec: 36.) <br /> lJ p ila S \A a Cal clan y ery- z Check#: I, 7 <br /> NA- �o be Used Mote �- 3 r <br /> of it (Ali I of 01 -is be py nl4+e <br /> m <br /> 0 I r <br /> Date of staff site visit: 6Ia)Z`( Initials of site visit staff: 1Lr T l co <br /> = dU <br /> APPROVED BY LAND SERVICES OFFICIAL`6 - ,likii*Lp DATE:(Jf/1I2DZ'/ m co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> L <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> Pagelof5 co <br /> Burnett County, WI Land Use Application-Rev 04/2024 _ �L - <br />