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LAND USE PERMIT APPLICATION -Burnett County, WI <br /> v, Nil <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Feeselease,check appropriate boxes) a d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Fp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �. <br /> rp <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- " <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r.o N <br /> Filling/Grading $150 Boathouse $500 , Z. ak <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. ' k <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. li <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> _ o h <br /> Property Owner's Name: 7 q r�enh(. =' <br /> N 11 00 1 ` <br /> a. <br /> Property Owner's Mailing Address: t -QC A3G�'i p,d 'rrc'tl�, 6)/ ,g~/64- 0 <br /> ' , City State Zip \, <br /> Property Site Address: ',.1I�I2,¢ A y:4/ rk b rfrO i, ti �', $ '���9 Z o y <br /> Contact's Telephone Number: 3. a. <br /> Contact's Email: v1.d^'VNY'y G nyigwy3(",',t • Co►'1 d <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 /> r � <br /> Legal Description of Property: lx) y,._ J�N W d <br /> Section#: L Town#: 3 7 N Range#: I b W Town of: Ta + 1—,;14-4. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . . c <br /> CC'Tax ID#(1-5 digit number;found on tax statement): Q 355 i lam' In <br /> Proposed Use of Structure/Addition: S e(c Ent) oi;!'= 1 Con 4,2v, 04 ey;S 4,n) ire vl v 1!W V4 sy <br /> Anticipated Start Date: rr (HomeXabin;Commercial Business;Bedroom;Deck;etc.) S W C.14 <br /> tL-t Building Ctmtror: cy(.) LtIn e P { Ag ) Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> Ie - qufie. 4ukS A <br /> Fee Rec:„ 3tr <br /> ° Check#: 9 7 33 <br /> z <br /> a <br /> 67 <br /> Date of staff site visit: 1 f' f2ozq Initials of site visit staff: — <br /> m C0 <br /> APPROVED BY LAND SERVICES OFFICIAL) (p DATE: ?/4i/;62"/"/ ` <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o= co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 5 <br /> Page l of 5 JJ <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />