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LAND USE PERMIT APPLICATION - Burnett County, WI G r <br /> a <br /> Applicant Complete All Sections Below This Line 0 � <br /> Permit Types and Fees�Please,check appropriate boxes) °' <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �? <br /> -Accessory Structure(Garage,Shed,etc.)v Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> W <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> TE:A e e-act r i r i fter construction has be un ma cost up to three times the normal ee. <br /> *Communication Towers, Camping Permits&Signs require a different application form,see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner's Name: ` <br /> 0 <br /> Property Owner's Mailing Address: 41 l � � 247 n <br /> City State Zip <br /> Property Site Address: o y <br /> Contact's Telephone Number: ° <br /> d <br /> Contact's Email: J S C Ct ►�.S g r'Y1 a7 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> 5' <br /> Legal Description of Property y. <br /> Section#: Town#: N Range#: W Town of- J�IG K S!lam ►�. N <br /> 0 <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* 00 <br /> P8 .f f S Y P PY .f Y P P tYPS <br /> Tax ID#(1-5 digit number; found on tax statement): V,1 <br /> d <br /> Proposed Use of Structure/Additi n: v a C/ out .� <br /> Anticipated Start Date: In (Home/Cabin Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: t,4,t w�� P�'� •F ,w US�ewe r hi taller: p s <br /> AREA BELOW THIS LINE FOR LANDS RVICES STAFF COMMENTS/CONDITIONS ONLY °m N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: e z o 0 <br /> 0,1\ 5C4�Q 645 < vl <br /> m <br /> N <br /> Qn d-4 +o b e u s e d. -Ro r 4u.vuan h a.d t 4 a-4,a n Fee Rec: 3 DX)C° <br /> °z Check#: <br /> r <br /> m <br /> v <br /> Date of staff site visit: <br /> h/-UZ5 Initials of site visit staff: <br /> ` 00 <br /> `D > <br /> APPROVED BY LAND SERVICES OFFICIAL 1 DATE: Z <br /> C � � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 00CD <br /> w <br /> � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> CD <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />