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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 0' c 4. <br /> Permit Types and Fees'Please,check appropriate boxes) °' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..� <br /> O <br /> FgAccessory Structure(Garage,Shed,etc.) $1501 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 "CDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 _Boathouse $500r <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 4 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ;.1? it, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' �- 1 <br /> z <br /> Property Owner's Name: /&°l'( I; /�/�G• C .r'5 ---2v 0 1 <br /> // 77Z <br /> 0 <br /> 0 <br /> a. <br /> Property Owner's Mailing Address: P,v , i5DX 5 d3 644..Si4 Jyf L-1-#K t v I y5p1 U <br /> • <br /> City State Zip c4 <br /> Property Site Address: /p C 4/ 3 Al G A-RA/c�—r.,scr/ LA-Itt d[D 1-06-1( L A 5-4/61s-3 o <br /> • C <br /> CD <br /> Contact's Telephone Number: 77/s yq C/ —d ga 3 a <br /> C7 <br /> ., <br /> Contact's Email: c% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N `d <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 0 °Q <br /> 5' <br /> 00 <br /> Legal Description of Property:1,O1',Z < 5m v.zc' Pi d <br /> Section#: 3 2 Town#: 3'7 N Range#: /g? W Town of: 77U4 L__,..4M67- <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page,* <br /> "3 o H <br /> Tax ID#(1-5 digit number;found on tax statement): 2 Y .Z 3 N <br /> d <br /> Proposed Use of Structure/Addition: S ter-AZ-er <br /> Anticipated Start Date: NUw (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x <br /> Building Contractor: Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z P <br /> v <br /> — Ilainn�,_� L,,_,I u, <br /> Ail <br /> A <br /> m <br /> ` ef �4 <br /> 100 176 05(4). Ass.r hkingayt MA-6`4.6 .-Zov1 w <br /> fr Fee Rec: 36 D <br /> CP- <br /> °z Check#: a1 U-a <br /> r <br /> 01 <br /> tr <br /> C L J <br /> pJ <br /> Date of staff site visit: 0` /724 Initials of site visit staff: G.L v <br /> C -o a <br /> _ <br /> APPROVED BY LAND SERVICES OFFICIAL: i/out ilmi i DATE: 0 /a/ZeZ't g coC n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 UT] <br /> v0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Im c <br /> Page 1 of 5 —� <br /> Burnett County, WI Land Use Application—Rev 04/2024 ,�- JJ <br />