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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line 6" <br /> CD 1 <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) � <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 vr,..) :Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure ,$150Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <. A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 N <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. - ` 6 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g ' <br /> z V) <br /> 0 <br /> Property Owner's Name: Tbd.4 f Ck.('s; Runt o <br /> o '► <br /> 1i a. <br /> Property Owner's Mailing Address: `� DL 1 �q f.ile>/i Ai owl Sj� 'i <br /> (� City State Zip ' <br /> Property Site Address: i 3O2 r tS ►`bd . 6 pr,odEA.. , i.v-+- -+f eo o <br /> CD <br /> Contact's Telephone Number: Co It.,- CAS-BC,5 1 ca. <br /> Contact's Email: 'hiro Cbt i 7 ,�.ti, I'.C.t�•cl e <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o <br /> o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov = °Q <br /> 5' <br /> fP <br /> Legal Description of Property: S=G Pt 1 n 4C gl i f PLt- &vs( iv" Z 4:tz- (LP` 7) g <br /> Section#: 2 4 Town#: LkO N Range#: /a/• W Town of: Scan' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> y '_ <br /> Tax ID#(1-5 digit number; found on tax statement): I �`t 5 i x <br /> d <br /> Proposed Use of Structure/Addition: 'Pn.'-i 40 H <br /> Anticipated Start Date: j t i 2 1 -' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Ins:•r Lic,-nt- Sewer Installer: CA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> 0 Pei JI 74 6_ ,1 7c Sa►,,., 901-p0ruf o.r t cQc4-, <br /> O 4.0m4 to -os- a ','9 6vait- 5tc Ore IAA YA, <br /> r t -n Fee Rec: lt‘ <br /> f/004/q/PI • 20/7r Z./d/Gl�' SN/DE.)S GI B /5 g4,01/'e, ° Check#:/ J'/ <br /> e - F404)_ <br /> h <br /> 3 <br /> it ///1 e e jcf 40GI • <br /> fo/Wo t) la t e/ ex lart / 94 r�/7 �e77411 071/te,v�eh7 ©c <br /> yeeq9?) r- ....r.=____2,\t:._j. ...) <br /> Date of staff site visit: 4/ //019Z5/ Initials of site visi staff: / /' Q M <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:/D/2V ZOZY fD ; -ty 0 <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF Y <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g -v <br /> __. <br /> Page l of 5 .L� j <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />