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, LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o cA <br /> Permit Types and Fees(Please,check appropriate boxes) e <br /> C7 <br /> XDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K NI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 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 /> C) ;b <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 or <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 U b' • <br /> Filling/Grading $150 Boathouse $500 r, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 v► <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. 0 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> o <br /> Property Owner's Name: �J i 0- C) /eke / Ch_i/n S,h«lA9_{-1/1 .e<Sy l / o yam+' b` <br /> ro. <br /> Property Owner's Mailing Address: ?g"C)(p / , �'•e'- .S— . �l meapt'}/�S In IV ST rd7 7 C Y k, <br /> _City State Zip E V <br /> Property Site Addressr: (o/ (c ib ec•7`S', k'I , tie kc4 �1 S`W225. < .P <br /> • c <br /> Contact's Telephone Number: 'his~ -960 ...I-6' / d 'be <br /> Contact's Email: 1:)(4.SpC -op.U%4 e y ck h a . e GM • b <br /> **If staff has a question abut this application, u will be contacted via email. Make sure your email address is N *ci <br /> �� <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 °O <br /> 5' <br /> Legal Description of Property: o <br /> Section#: Town#:_ ?S � a N Range#: L� W Town of: . // <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* va <br /> C-4 G o <br /> Tax ID#(1-5 digit number;found on tax statement): 9? of <br /> Proposed Use of Structure/Addition: D(.,)e r•7 , 4- O Ss1 <br /> Anticipated Start Date: -ay (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) T\ <br /> Building Contractor: Sewer Installer: J1C S('4') Uih 4,„ z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o po <br /> z <br /> - M & oust sd m �c <br /> . 9- o \, rn <br /> ›• ilszyf <br /> Fee Rec.. <br /> ° Check#: (936-9 <br /> 046,/ \rah bolt, SAt kt kAitS ov\ -,Ar.e. pl rtlA I ma -o m Ub L cp U <br /> cunt, o4}o,1v\ VDU r-ti' VC d -"---' <br /> Date of staff site visit: ?1 1112c'?lf Initials of site visit staff: 6L a n <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: J1)Ø4' L DATE: 7/i2/� -0 coo W r a <br /> � <br /> o <br /> Si c0 f <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 ,.,, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rffi <br /> a <br /> Page 1 of 5 Q.: _Jj <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />