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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) o C7 <br /> m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 O <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(ly)Structures $350 r <br /> 0 <br /> Filling/Grading $150 113oathouse $500 N <br /> Solar Panels(Stand alone or roof mounted) $150 1 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 /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treate as accessory structures,such as:pergolas,landscaping,etc. <br /> z • <br /> n o <br /> Property Owner's Name: 8 W <br /> Property Owner's Mailing Address: 30 68q )0 )5#4 0", 1\i <br /> �t r, �ty State Zip 4 <br /> Property Site Address: <br /> Contact's Telephone Number: <br /> 0 <br /> Contact's Email:_ J <br /> **If staff has a question about Phis app ication,you w 1 be contacted via email. Make sure your email address is IN b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov tl0 <br /> 1 c9 'J CSC►..L/j bi?�`2 (4�'AWY)�6oLegal Description o Pn:�pc,rty: - N <br /> Section Tov,-i#: 44__ N Range#__�S _W Town of: S t j S� <br /> *,attach additional page{rneeded.for lengthy description OR attach a copy of the deed OR attach tax system property page.* � <br /> / lv E k <br /> Tax ID#(1-5 digit number; found on tax statement): Zl `� -c d <br /> Proposed Use of Structure/Addition: 6woir _ N <br /> Anticipated Start Date: In— (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) l/ <br /> Building Contractor: �L97 _ Sewer Installer: 4 <br /> AREA BELOW THIS <br /> L'I�NE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY e <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> W — <br /> N0� 40 US l Y �u vna�rl �a �► `o� m <br /> Follow ct,�,t Fee Rec: <br /> (e S-h �- -4i o►�S T►�ea�e d l m�e�v�i �, ,r�ue�s l�j ree - <br /> ° Check <br /> z <br /> r <br /> A <br /> m <br /> n <br /> m <br /> 1 Z 2s� )(2�I25 <br /> Date of staff site visit: ��Q ��IJ�n//itials of site visitstaff: � d- >APPROVED BY LAND SERVICES OFFICIAL`r�� h0dlr,'-� DATE: <br /> �— <br /> CD 9iCD <br /> t <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD <br /> 00cc <br /> � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r <br /> Page 1 of 5 -j <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />