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LAND USE PERMIT APPLICATION — Burnett County, WI ro <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,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 /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 O <br /> Driveways/&Campground Structures $125 1 IWI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 @ <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 �A <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. <br /> z <br /> 0 <br /> Property Owner's Name: e!/E r o <br /> 0 <br /> CL <br /> Property Owner's Mailing Address: k k i 3 0 c� I� Yl >7_ -1 S�/ S E. , <br /> City State Zip ° 4 <br /> c. � <br /> Property Site Address: `�-� 1 ;+c k c c z o <br /> c <br /> Contact's Telephone Number: 7 S 7 9 - 3 0 ° <br /> C7 <br /> Contact's Email: f"C) co— C a ire <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro "0 <br /> 70 <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov S <br /> Legal Description of Property: ( L 3 d <br /> Section#: Town#: 4f 0 N Range#: !! W Town of: 5 C Cl tl 0' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> d <br /> Proposed Use of Structure/Addition: 66 i r ccc .� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x <br /> Building Contractor: Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> rn \ v rta,n ha b�-Ir,�+'on � Srfura5 o Inty m <br /> V N 0+ -}o 'jae. jj ,t l -�o r 110 <br /> 3 I v k -b k 16-n � C" ZO Fee Rec: <br /> D <br /> � Qlumbtn� t�- IS (0��1{f��J C COC6 C0M1 +p ° Check 3v <br /> SySEe m fa It by ct wf l,ic, tu� rlu rube r' <br /> &�P-8 �n l tse Rx-rni+ by n�eQ�� � d <br /> Date of staff site visit: �l Z�2 Initials of site isit staff. 1- > w` <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z02n� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Q= N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />