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v) b <br /> . LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o CD I <br /> Permit Types and FeestPlease,check appropriate boxes) a <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 ( , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v 0 OW <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G- a" <br /> Deck/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 $500 t <br /> Solar Panels(Stand alone or roof mounted) _$150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `$ <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. b -- <br /> z <br /> c� <br /> Property Owner's Name: 1�4 ,4 t✓ , El ( ( . 6 <br /> v b tt�� I <br /> F <br /> Property Owner's Mailing Address: LI 3 41 / E lJ & f o/ -0 n <br /> , s \ _ State Zip cn <br /> Property Site Address: `' !� �� l.V(5 CoUSk {� 5 -5 O o N <br /> 111, <br /> • <br /> Contact's Telephone Number: (e cl - 7-SE -- 13 02 D a \ <br /> 0 <br /> Contact's Email: 141<o>4 7 - -,1)(;_(-0 crovi( S 1'(est ' <br /> **If staff has a question about this applicat`lerr;you will be contacted via email. Make sure your email address is 0 • ' <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov r- <br /> 5' <br /> as <br /> Legal Description of Property: d P <br /> Section#: C')C1 Town#: T U N Range#: / tY" W Town of: O.4-jL L.-4-pU Dc N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7 c4 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 Gl, U" <br /> i C7 <br /> Proposed Use of Structure/Addition: Ca F (r�' ri <br /> Anticipated Start Date: £)C+c f'y 7_0- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) VJ <br /> .'-C <br /> Building Contractor: Sewer Installer: y - W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> o <br /> NO4 Ao lot e U -Foy kv�w un Iacx1oi4u-hl en <br /> _ <br /> CD <br /> 0.kt0 ca.n,d decks I Ect ct Land vist +10-1 t 2 II itozil ' Fee Rec: lr� <br /> q� °z Check#: i 9'/7 y <br /> r <br /> P <br /> m <br /> al <br /> Date of staff site visit:/O/Z/Z02 Initials of site visit staff— a Y <br /> APPROVED BY LAND SERVICES OFFICIAL C{,Llil Y gtfir6 DATE: 110/ tq `-, , ' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �CD a _ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N <br /> Page 1 of 5 <br /> L..(:.. )) <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />