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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> a g <br /> Applicant Complete All Sections Belo i This Line 11.4 <br /> Permit Types and Fees(Please,check appropriate boxes) 3o <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 g NI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 S �� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 5. <br /> `C <br /> / Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 O <br /> V Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o , <br /> P <br /> Filling/Grading $150 Boathouse $500 �( A <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. `q <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. <br /> z <br /> O <br /> Property Owner's Name:�(��ne M tf�U►ri C� �� <br /> 0 <br /> Property Owner's Mailing Address: 1077 WI 5l/2 3D E.S �Sl�.y � D���,. <br /> n� �e v ity State Zip <br /> cip <br /> Property Site Address: s�iq I� 11I1v1° / 11�1� WI 5�801 . . <br /> Contact's Telephone Number: 7/5'733—O 55 0. <br /> d � , <br /> Contact's Email: Gunn cite I1 o hw C. Corn <br /> **If staff has a question about this application,yo ill be contacted via email. Make sure your email address is N -o it <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 0° <br /> 5' <br /> go <br /> Legal Description of Property: RoOYnC.t j Lake fines L' (O 'I N )'Lai-7 d <br /> q <br /> Section#:_ I 1 Town#: go N Range#: 1 L W Town of: 5cott <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> o <br /> _ <br /> Tax ID#(1-5 digit number;found on tax statement): Igo?a�7 N ..-- . d <br /> Proposed Use of Structure/Addition: UGC. W/&utrc -- <br /> Anticipated Start Date: I-(a-a y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> n .. 't. NI <br /> Building Contractor: SQ,IC Sewer Installer: Iniaw O fi -J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS/ SUBJECT TO ALL CONNDITIONS LISTED BELOW: d x <br /> 6 cn <br /> f//o oil cokdl'74 &,4,‘ vbR- Z'- /D. Co ptime1/- < <br /> m <br /> F <br /> rt <br /> / m <br /> cn <br /> FAA I`y /00Ore. - wl e co/15 f.v v4 77ay4 1/i s%oh -6.'1" rzi <br /> _ <br /> m Fee Rec: /3 <br /> ,44 A74�h re?CA I'NeNt4-e.✓1 fsa z Check#:,7).....W5 <br /> K <br /> c, <br /> ni <br /> ni <br /> CD <br /> Date of staff site visit: V20c9 ZY Initials site ff: f/ a <br /> APPROVED BY LAND SERVIICES OFFICIAL: TE: 7 /g Z4Z coEVE1 <br /> 0 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 0 g �v <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3" <br /> Page 1of5 —�.7 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />