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LAND USE PERMIT APPLICATION — Burnett County, WI c R <br /> Applicant Complete All Sections Below This Line 04. <br /> Permit Types and FeesPlease,check appropriate boxes) a <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure .$300 Addition/Alteration to Commercial/Industrial Structure $200 I" O <br /> Accessory Structure(Garage,Shed,etc.) $150 )( Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial).$200 Addition/Alteration to Bunkhouse 0 ~ t <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° \ j <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 _Boathouse $500 cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0 i <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `$ <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *items not listed above will be treat as accessory structures,such as:pergolas,landscaping,etc. ` <br /> Property Owner's Name: /e9/2..ei.3 t /0 /f 1 i-� c • <br /> tll / ' E <br /> Property nOwner's Mailing Address: J .fn,1� tz� E. n N <br /> Property'cS/5"3 pa�',�ess: f$Z7/2l Po O x ( , City 9Yzip Zip <br /> Contact's Telephone Number: "-c 2 ,' — /5--- __3 <br /> Contact's Email: C /r�/(1 ` --C /7 f 441Z.---- s <br /> **If staff has a question about this ap 'cation,y d will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0 °Q <br /> // �-- pi) 5. <br /> 'f <br /> ao <br /> Legal Description of Property: !� /o /.l SiCi( (-4 �e c b --� <br /> Section#: ) Town#: �Q N Range#: /l0 W Town of: kkKc n W <br /> *Attach additional page if needed for lengthy description OR attach a cgpc' o he dee OR attach tax system property page.* v� <br /> Tax ID#(1-5 digit number;found on tax statement): 7 0 <br /> r a d <br /> Proposed Use of Structure/Addition: C f a//'a< — Aa,r77e,� -3 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x <br /> Building Contractor:f17r4_ 1 sly De cte Sewer Installer: 0 ---C. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY tr <br /> o <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> 0 r t4 alb 3x+190 3 <br /> ri <br /> Noy ustd -RYhxxim 61-I-w-h <br /> Cr� p ,, I - /� Fee Rec: /. f'� <br /> I T u��a J a/i` �1 ICC6l11% -r'M LU,1' -Z.Z-522 2 Check#: to gI <br /> 5 <br /> , ...,s,... <br /> .� <br /> ,:, <br /> ,i„„ <br /> Date of staff site visit: WON Initials of site visit staff: CAL - k 3�CO C <br /> APPROVED BY LAND SERVICES OFFICIAL U.(Q_--}? tJ) DATE: (Q/21 �� Fi ` o Effl <br /> J v' 0 ti <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , I tEffil <br /> Page l of 5 JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />