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LAND USE PERMIT APPLICATION—Burnett County, WI f <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co •` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 U O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 10 �� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 10 <br /> Filling/Grading $150 Boathouse $500 PIA <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. &v <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. °m. <br /> o ~ <br /> Property Owner's Name: RAID•1 � sltI,e /44-Okta - N <br /> ty <br /> o t.. <br /> 0. <br /> Property Owner's Mailing Address: 13 1 T1LA4"6,5 _ (grArbav, l 5-4' .0 N 'V <br /> City State Zip E <br /> Property Site Address: 5ft*tc /N5 4664 o � <br /> Contact's Telephone Number: (Q5! -3O.7 --$/Se <br /> o <br /> Contact's Email: '3'‘);5, t pi,, rrf ® v}o,� ,con C <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is d '9 <br /> i <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov ' -c N <br /> (� RI�A2 2-- as N <br /> Legal Description of Property: iC SsjTN A�$ O OS— TLIw 3 avpleoty 66446.09, OF u <br /> Section#: 2l Town#: 39 N Range#: 19 W Town of: t 6tc 0 <br /> M4a,544,41)A "� Qv <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* (1' <br /> �" <br /> Tax ID#(1-5 digit number;found on tax statement): 3tP�(1 � kA .J ,E <br /> Proposed Use of Structure/Addition: 6.7A4' -� W <br /> Anticipated Start Date: I 0-I U-L (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> - <br /> s <br /> Building Contractor: �0c• Sewer Installer: N'Ptn <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0CA <br /> III <br /> (D No4- --ko be VS.k8 4 Y 6,,YAC "‘ V\c),J01f v- i°n , <br /> Fee Rec:i 1.50 <br /> ° Check#: (I 3 I <br /> z <br /> x <br /> m <br /> n <br /> 0 <br /> Date of staff site visit: I Di L 1202-I Initials of site visit staff: T I <br /> q �h �° c' d`�li � <br /> APPROVED BY LAND SERVICES OFFICIAL. ,C�l a ` DATE:lol 1 /2024 r j <br /> 2 C� ha <br /> APPROVAL: APPLICANT MUST POST COPY OF `". <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 Ill <br /> Burnett County, WI Land Use Application—Rev 04/2024 `- JJ <br />