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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> a <br /> Applicant Complete All Sections Below This Line 0 <br /> CD i <br /> Permit Types and FeestPlease,check appropriate boxes) .,(\ <br /> G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> • �Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> c Accessory Structure(Garage,Shed,etc.) ,$150 Addition/Alteration to Accessory Structure $150 p�_ <br /> / t <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 iV <br /> n VVV <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ,) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> ` <br /> Filling/Grading $150 Boathouse $500 <br /> c <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. _ <br /> b <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. b <br /> •• II E,- o <br /> Property Owner's Name: _1PC N PA l�() L I ALSO) <br /> i ^/r' vA/nA� f °6 1 <br /> Property Owner's Mailing Address: tF 3 2-� 'MD'--�_D h I I( lA t !"E 0-NA 5S %d n • <br /> 4 nn f; ,� A,�� y State Zip a c) <br /> Property Site Address: Q 6� F f ( P-Wou 17 f � w ebfie2(.v i o N <br /> Contact's Telephone Number: <br /> (p S ] 0 <br /> ( S. (p G I a <br /> Contact's Email: J (A) tN2l/ 3 CO I'lel CQ t` 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 0 °O <br /> Legal Description of Property: et/2.. Ne_5 C, L4 `VP & '.l kt, d <br /> ,.. <br /> Section#: 17---' Town#: �� N Range#: 11 W Town of: �/1/C__01--!" a. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* `4 <br /> Tax ID#(1-5 digit number;found on tax statement): O <br /> n^ o 7 <br /> Proposed Use of Structure/Addition: -_ 17) 64 GE e_op rZ' H <br /> Anticipated Start Date: .J(,( ome/Cabin;Commercial Business;Bedroom;Deck;etc.) c!1 <br /> z <br /> Building Contractor: Sewer Installer: <br /> cA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zpzJ <br /> v _ <br /> - I ek a Sckka,i l-, kctkwbre MIAs <br /> ri <br /> \lb- ,CC bt, SC(J�t Sk W�� - 0- �Y� Pa l�' • \�( b/ /7 L� Fee Rec:� <br /> °z Check#: (lc :/- <br /> r. <br /> m <br /> Date of staff site visit: Ofri IZK Initials of site visit staff: ,,� - ID <br /> ID <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 DATE: 7/2J Zciv( c, c r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o g <br /> � m <br /> m U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a E 1-1, <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 �1 <br />