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LAND USE PERMIT APPLICATION — Burnett County, WI et b <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and FeesiPlease,check appropriate boxes)- a <br /> O <br /> Dwelling/Principal Structure $300 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 $150 „ <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 <br /> Filling/Grading $150 Boathouse $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. <br /> z <br /> 0 <br /> Property Owner's Name: M 1 C h`t'G ) br. c <br /> cJ o. <br /> Property Owner's Mailing Address: J C "�' j t' r �v i <br /> yo' .Zqq�3 l City St�e Zip <br /> Property Site Address:L u C S M i�x ry�1 iJ �tt ��aT` c <br /> H <br /> L 2 <br /> Contact's Telephone Number: <br /> p�}5 ? — ,//C N <br /> Contact's Email: >�ll bi5o�c i�rACj, <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 <br /> 5 <br /> pp as <br /> Legal Description of Property: (0 o W <br /> M. <br /> Section#: �`( Town#: k1 N Range#: _W Town of: W; 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> > vl o m <br /> Tax ID#(1-5 digit number;found on tax statement): (, /Z� <br /> Proposed Use of Structure/Add't' .� /Y J C)v V 1<4"o r A-1 <br /> p J l 115 1'1-1 <br /> Anticipated Start Date: H me/Cabin;Commercial Business;Bedroom,,Deck;etc. N <br /> Building Contractor: Sewer Installer: f yid• .I <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 /> `a <br /> I Fee Rec: <br /> °z Check#: 9 O'l U <br /> r <br /> -C <br /> Date of staff site visit: � 12D2,q Initials of site visit staff- +• D g <br /> APPROVED BY LAND SERVICES OFFICIA DATE: f Mo 9 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />