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LAND USE PERMIT APPLICATION -Burnett County, WI ro <br /> a <br /> < b <br /> Applicant Complete All Sections Below This Line <br /> CD <br /> Permit Types and FeesfP/ease,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 9� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure t5DO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \ �` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° �J { <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> ti <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 �"� <br /> t*CoEuEnicantionTowe�rs, <br /> mits(peree times t e normal fee.Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner Name:'' 1 `>cz o <br /> Property Owner's Mailing Address: 1 G L - 3G 9. n •o <br /> -- City State Zip W <br /> Property Site Address:�� cp Gzi �6t D PQ( Oev-- o <br /> y <br /> G <br /> Contact's Telephone Number: <br /> Contact's Email: O AA a s ct—L 1 1,J WA <br /> **If staff has a question about this application,you will be contficted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov N <br /> Legal Description of Property: cle O wS LOT 1 l y I n><i IN oU T Lo r5 <br /> 11 II <br /> Section#:0_Town#:4_N Range#: _W Town of:D(A G l0.n d <br /> *Attach additional page if needed for lengthy description OR attach La/copy of the deed OR attach tax system property page.* v� <br /> Tax ID#(1-5 digit number;found on tax statement): `"1 3JlP WSJ a <br /> d <br /> Proposed Use of Structure/Addition: -� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Anticipated Start Date:CbYy*tA A914 � s <br /> x <br /> Building Contractor: Sewer Installer: y o r, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m z 6' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z �d v <br /> v <br /> m <br /> O rAEET Au— SC-T 8ACk-S < � <br /> m <br /> NOT 'TC B& USED Foit VAUW46 &) NR$I T-ATt oA/ y � <br /> Fee Rec•:5-6,DID <br /> 03 t R v Y Qut t}ou S>c -M 0e PERw.t mEo of? z Check#: <br /> Date of staff site visit: i 2 27 Z� Initials of site isit staff: D3 KT' M <br /> C-) <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: IZ4 <br /> ZI�L ? ro <br /> O 0 c ca o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD M <br /> Page I of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />