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• LAND USE PERMIT APPLICATION — Burnett County, WI ro r <br /> a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and FeestPlease,check appropriate boxes) a <br /> d � R <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD ,•,'� <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 F0� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 0 <br /> 0 <br /> Filling/Grading $150 113oathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 R. <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <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 /> Property Owner's Name: \�;°r". L� L�y� G SSI �� �.�L- o )' <br /> a �1 <br /> Property Owner's Mailing Address: ( e_c LK <br /> City State Zip ° <br /> Property Site Address: c <br /> c <br /> Contact's Telephone Number:711 S_ tests _ ?mac cis 1� 'r �f 1 c� d <br /> Contact's Email: MGLJ .(L %m <br /> **If staff has a question about this application,you will'be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> 5' <br /> o� <br /> Legal Description ofProperty:L-C f c" �l/n \.--),qD Z- (n P 2,.') d <br /> Section#: `-- Town#: �U N Range#: W Town of <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number;found on tax statement): f 6 <br /> Proposed Use of Structure/Addition: \ l 4eM <br /> Anticipated Start Date: (Home/Ca 'n;Commercial Business;Bedroom;Deck;etc.) o� <br /> Building Contractor: Sewer Installer: <br /> -jjP "23 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> z <br /> THIS PERMIT IS SUBJECT �TO ALL CONDITIONS LISTED BELOW:/ o <br /> 15 / ae. � ctr14 Xp e✓` f -S .�kk tray -ell 6 <br /> n <br /> �`� L��Z3- 7S3• m � <br /> M <br /> m Fee Rec: a � <br /> z Check#: � <br /> r <br /> C <br /> M <br /> m <br /> v <br /> ,,// Initials of site visit staff: GL . f <br /> Date of staff site visit: �` �tiLf 0 23 �f v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /Z 7.4 Z cn m�o C <br /> 2 3 Z <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF a a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT G <br /> C 3 <br /> Page 1 of 5 ` <br /> Burnett County,WI Land Use Application—Rev 04/2024 ' <br />