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LAND USE PERMIT APPLICATION - Burnett County, V" a b <br /> Applicant Complete All Sections Below This Line ' c t� <br /> Permit Types and FeestP/ease,check appropriate boxes),! ° <br /> C 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \Ay O <br /> Accessory Structure(Garage,Shed,etc.) 1 Addition/Alteration to Accessory Structure $3s0" O <br /> ., <br /> co <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 R? <br /> 0 b <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 1 jWl State Statute 59.692(1v)Structures $350 S 1 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 1 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-t e-act permits permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <br /> *Communication Towers, amping ermits&Signs require a different applicationjiarm;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> z <br /> 0 <br /> Property Owner's Name: <br /> a -C <br /> Pivperiy Owners Mailing Address: S S [? A071n <br /> i State Zip <br /> Property Site Address: 02 -7 j � /L 5't f1'73 0 <br /> N <br /> Contact's Telephone Number: 7 1 - 7 3 3 -41.0.3� <br /> �v C <br /> Contact's Email: <br /> **If staff has a question aliout this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov d0 N <br /> Legal Description of Property: <br /> Section#: 25 Town#: yd N Range#: I S W Town of.TL-CkS&-) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number; found on tax statement): S9W 3 <br /> Proposed Use of Structure/Addition: y y W <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> z a W <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> �rtGlis rmi f i S - e �(�' x Ito' shtc� < <br /> I Fee Rec: <br /> a44 V(.�WS, par(,d S 4D � l e�� (ombt Check#: 4 9 <br /> itit-wt 0. Ce r4i eJ SVAA 61 $130IM5. <br /> Date of staff site visit: 2�71�Z 5 Initials of site visit staff: <br /> 4 C m <br /> �. <br /> APPROVED BY LAND SERVICES OFFICIAL:�(UAG iak62 DATE: Z Iza 5 <. )> <br /> CD `= <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 � <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />