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10 <br /> LAND USE PERMIT APPLICATION —Burnett County, WI & r <br /> ` a <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees�P/ease,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> r O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � \� <br /> v Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> M <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk iBunkhouse $250 1m °< <br /> Driveways/&Campground Structures $125 jW1 State Statute 59.692(iv)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 iPermit 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 /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <Kl- <br /> z <br /> 0 <br /> Property Owner's Name: AU& 0 N _ <br /> o ,jg' <br /> Property Owner's Mailing Address: /4 U - R. CINI IV <br /> N <br /> City State Zip ° <br /> Property Site Address:_ -3 Yi5,;7- e-,z &Ak r Z o <br /> N <br /> Contact's Telephone Number: e�)S! �� S <br /> �n d <br /> Contact's Email: t7 L1 ?,9 (IT-1 (374l&Z- <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 00 <br /> ^ <br /> Legal Description of Property: K/L /7P "/Aj &p !2; ® l f_ <br /> L��� <br /> _ / (�� d <br /> Section#: �) Town#:-r � N Range#: W Town of: JA<t�Sa/J -A <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number; found on tax statement): -7674 -7 I" 7-'� (�1 <br /> Proposed Use of Structure/Addition: GRk&-,!� --,TeP 6 <br /> /4 <br /> Anticipated Start Date: sAe Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: A&6p., RGJ :57ef L_ Sewer Installer: A) /� y 0 � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z .0 <br /> m 'n <br /> < V` <br /> n <br /> ►vo -b be u�d -fir umua� hab�- al I1' _ ���/ <br /> CYO Iyl �, D� ��P�f� �"` ' ""In 7 ��O 6S -71 <br /> Fee Rec: ���rUd <br /> CQ `� °z Check#: 2-0 <br /> r <br /> -C <br /> L, <br /> Date of staff site visit: 7 I5 S Initials of site visit staff:� a 1FYI <br /> W C, �- <br /> APPROVED BY LAND SERVICES OFFICIAL. _DATE:'1 Z�J ZD 5 <, X� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> � C <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />