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c b <br /> LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> Applicant Complete All Sections Below This Line 0' N N <br /> Permit Types and Fees�Please,check appropriate boxes) n <br /> C7 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .� O <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 /> 0 <br /> \ / Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °a° G <br /> �(\ Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 <br /> va <br /> Solar Panels(Stand alone or roof mounted) $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 /> -o <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. o <br /> z <br /> 0 <br /> Property Owner's Name: <br /> �l LOT- <br /> Property Owner's Mailing Address: O��1 (,Yt� 1/✓ S` w. <br /> .I 2 City State Zip ° <br /> Property Site Address: ( <br /> o h <br /> Contact's Telephone Number: S� SSX-"C>Y10 n <br /> A d <br /> Contact's Email: <br /> **If staff has a question about this application,you wine contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov R 00 <br /> pp 22 5' <br /> Legal Des tion of Property: <br /> Section#: Town#: / N Range#J_�_W Town of. M1 .e—e <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v� <br /> GC o <br /> Tax ID#(1-5 digit number; found on tax statement): � .A W f <br /> Proposed Use of Structure/Addition:_ -� <br /> Anticipated Start Date: (Home/Ca in;Commercial Business;Bedroom;Deck;etc.) <br /> LA <br /> � n x W _D <br /> Building Contractor: Y a tiVY't >-P h Sewer Installer: N <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> 0 <br /> m <br /> 0 Shy (MnO- b� vkd <br /> n Fee Rec: Z-l5'yo <br /> °z Check#: <br /> (Af k Pd-, <br /> 1 <br /> Date of staff site visit:1 ZoZzl Initials of site visit staff. + LB a CD Q <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: Z 4 D r -T a�� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF s <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1of5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />