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LAND USE PERMIT APPLICATION-Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c� <br /> s <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 fT1 <br /> Filling/Grading $150 Boathouse $500 <br /> m <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 /> m <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. V <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -' <br /> zZ <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: new �J,T��'V1- MN SSI'lZ I r th„N� <br /> City State Zip <br /> Property Site Address: Z ka,\S C oy" L1�-,c ROU� , D,,y1 biA,y t WT- '7"Ue - <br /> a c <br /> Contact's Telephone Number: 01S- <br /> 0 <br /> Contact's Email: y)S-�e� C(og1 �yA 661 • C OV-1 <br /> **If staff has a question about this application,yo will be contacted via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following address: a)BurnettCountyW1.gov N <br /> 5' <br /> Legal Description of Property: n- 0118 '2 �A P- 1-� DO (,52C oo ON <br /> Section Town#: N Range#: W Town of: <br /> *,9ttach additional page if neededfor lengthy description OR attach a coPe of the deed OR attach tax system property page.* a <br /> p a o <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: one <br /> Anticipated Start Date: O'' -IS- I C) (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) r <br /> Building Contractor: N1( S- e'k . (0WV1U-) Sewer Installer: �Njcldt RL4,i Ol�'►1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COlknIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> U <br /> rA <br /> < s <br /> Y104 4D �y e-cd 2 rooms PP,+r S0(N#k 2yo5q 0,1j ve con nec+i�1 <br /> Fee Rec: 6- (Do <br /> Check#: <br /> ,� re movt d 6y -ft I6 o;, Ekei fa-+;bra da4 `I 1,4 <br /> 2oz� <br /> 40 be (e,m,00j or Kjwlk JOY y I l 20z S < <br /> Date of staff site visit:Aq aI _ Initials of sit visit staff: + <br /> LlAPPROVED BY LAND SERVICES OFFICIAL DATE: 7 �� `9 n <br /> - '1�,-F <br /> < � <br /> �T " C-) <br /> UPON APPROVAL: APPLICANT MIDST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT � a <br /> Page 1 of 5 <br /> CD <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />