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LAND USE PERMIT APPLICATION —Burnett County, WI .. r <br /> < b <br /> Applicant Complete Al!Sections Below This Line a. A <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) d <,0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 kl) g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 cn <br /> b <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `. At <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i" -' 1 <br /> o (A <br /> S/ I""!'�f I�Ar c3)1/� p T <br /> Property Owner's Name: / C l" cCY?�Se` o <br /> (J O& (�AZ r n 1 � 7L <br /> Property Owner's Mailing Address: l �!»/1/1 I(G D (2�� a cn 1 <br /> �(0O(Q 6k/A toe/2,4 o Ctty11 S at i ( Z� Ig 7`- < <br /> 1. <br /> Property Site Address: /4L o <br /> - 272v . in <br /> z Contact's Telephone Number: G1 i <br /> Contact's Email: SN 6 Al7)„..) e 6-.77-,<1/L , �l�'vJ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .t, ' <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 5 tl° <br /> 5 --St- <br /> Legal Descrip/Itio of Property.2 p ,J P.Section#: ! Town#: /D� N Range#: /7 W Town of: Del IA 1 t S <br /> Et <br /> g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* &) <br /> imTax ID#(1-5 digit number;found on tax snntatement): /v N\ ' o <br /> l Proposed Use of Structure/Addition: A /2'i % ,�1&&L r 5/16-(. -3 <br /> Anticipated Start Date: /ni1 'ti (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `-, A <br /> Building Contractor: Sewer Installer: 7, ", <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rri <br /> o �1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d pz <br /> n <br /> m <br /> N <br /> ..] <br /> m -rye <br /> Fee Rec:/' .V <br /> °z Check#: wer,.7j <br /> r <br /> rn <br /> rn <br /> n <br /> o0< U <br /> � <br /> Date of staff site visit: 5' ? 2 'Z� Initials of site visit staff: ,1/. n <br /> Ill! b D <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 5 04'Z `D i <br /> La: tad <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF N o <br /> Do <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> CD <br /> CD [1111 <br /> Page 1 of 5 = <br /> Burnett County, WI Land Use Application—Rev 04/2024 `- JJ <br />