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11 <br /> LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> C � ` <br /> a. b <br /> bi <br /> Applicant Complete All Sections Below This Line ' <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $3001 Addition/Alteration to Dwelling/Principal Structure $200 ^O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure 'J <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 <br /> uz <br /> Solar Panels Stand alone or roof m 't Extension 1 Year Extension-Allowed Once) $100 . <br /> NOTE:After-the- three times the normal fe <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. <br /> z <br /> 0 <br /> Property Owner's Name: -7 � =� <br /> 0 <br /> ' R o <br /> Property Owner's Mailing Address: 3 t/ 5 Lv j"�-. " �.� f')�J SS�'S c' <br /> ,• n <br /> CL n ' City State Zip V) <br /> Property Site Address: 2,7�2G', S kSL-, l� <br /> -7 rrZfO <br /> Contact's Telephone Number: / �i b I � a <br /> d <br /> Contact's Email: a Z-rt P 9 4 F--,`.�:'^^��� �.d �. =% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails(s from the following address: @BurnettCountyWI.gov °Q <br /> Legal Description of Property: P\a.V o- 5�"'"7 ��c _ z= V- d <br /> Section#: 7-S Town#: 4V�-; N Range#: i 1�/ W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> Tax ID#(1-5 digit number;found on tax statement): 2 S Is <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (HomelCabin;Commercial Business;Bedroom;Deck;etc.) N <br /> S <br /> Building Contractor: ����-� Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> Loc:�aNda/it 7� b e /k STD/� �u 5 JPDi�c T�S�� /�' <br /> Fee Rec: 3 <br /> ra v z Check#:`C% <br /> z <br /> m <br /> < _ <br /> L� y <br /> Date of staff site visit: I1-71& / Initials of site visit staff: / a I <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 17 1 <br /> aI <br /> s <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF - � <br /> 00 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT W'LN C <br /> Page 1 of 5 . <br /> Burnett County, WI Land Use Application—Rev 04/2024 w <br />