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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a. <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and FeestP/ease,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° r, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 o V <br /> Filling Grading $150 1 113oathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ". <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. or <br /> z <br /> 0 <br /> Property Owner's Name: l o N N <br /> \ <br /> Property Owner's Mailing Address: cQ3 A c.. 2J S iv <br /> City State Zip Un <br /> Property Site Address:, t f �� iZ� c <br /> a <br /> Contact's Telephone Number: S �I / •1 <br /> Contact's Email Ckvv\f t� u XYv CD <br /> **If staff has a ques ion about this ap—pTicaifon,you will be contacted via email. Make sure your email address is N IV <br /> legible and your email provider will accept entails from the following address: @BumettCountyWI.gov <br /> Legal Description of Property: k of � �S fig U .��. � d ..D <br /> �. �. -..P <br /> Section#:S—L Town#: N Range#:� W Town of. ctc �r�r. .� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v� <br /> 73 <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: F—,, We <br /> Anticipated Start Date: (x rnelCabin;Commercial Business;Bedroom;Deck;etc.) N <br /> z <br /> Building Contractor: 5-11 1 Sewer Installer: d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z �, <br /> D kfce(S --It �¢e combined [A 7+ R Ger44ed Su✓�ey rvlap(c�r�) A <br /> by I 'IZDZ5 <br /> co <br /> y CC <br /> G <br /> Fee Rec: of QQ <br /> I�oI„-ti heal s a land Use Perm*+ by � 130I2�vI z L 1 <br /> ° Check#: <br /> z <br /> Dtre�M n t10-} �o �x.ce ed 3 be�lro�snS der Sfl�1�2225$ �` __ _ <br /> u 16�kw DVdCLW5 CtC4 jut�c) (nSPAI( -ft( any VU(esSar 1 perm` S < --; <br /> I \ CL <br /> Date of staff site visit: Aj) Z02,q Initials of site visit staff:4<1` 1- 4J g <br /> t&q <br /> a cn oo C�3 m c <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: <br /> cu <br /> Do <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD a <br /> SIGNED PERMIT_ APPLICATION IN PLAIN SIGHT T <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />