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b <br /> LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a ro <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees:Please,check appropriate boxes) a <br /> t7 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> IDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 LID <br /> Solar Panels(Stand alone or roof mounted) 1$150 jPermit 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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> � _ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> z <br /> 0 <br /> Property Owner's Name: SMitt o N <br /> o <br /> Property Owner's Mailing Address: '] r R n <br /> City State Zip <br /> Property Site Address: `3 11 O o ti <br /> Contact's Telephone Number: (Qf c 3 '�D�—Z � a <br /> Contact's Email: h M CX 0 4YXC-0—zft, n <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�froom the following address: @BurnettCountyWI.gov °Q <br /> Legal Description of Property: �,,�rAU L .15 t i 2 7 d <br /> Section#: Town#:_3� _N Range#: _W Town of: IrV'�p id.i� � � ►" <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* vi <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> ~ Home/Cabin,Commercial Business;Bedroom;Deck;etc. <br /> Anticipated Start Date: "-at, <br /> Building Contractor:Dp " Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> Obtck mush- <br /> rq u,i(,,e,m,¢, -Rr c) or Z <br /> Fee Rec: 125 <br /> °z Check#: 13b <br /> � d17J c, 660 neeAt� oYl S -{�c �a n t� 11cIS SOY 5 t 2025 <br /> m <br /> Date of staff site visit:l 1 ZD2�� tbJ2y 2� Initials of site visit staff <br /> n <br /> �n w O <br /> C-) <br /> APPROVED BY LAND SERVICES OFFICIAL4-���l DATE: 3 CD <br /> FU <br /> CD GUZ i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD <br /> CD <br /> Page I of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />