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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Linefit <br /> a <br /> Permit Types and FeesfPlease,check appropriate boxes) t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r11 cv� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �C O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Rm) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t7 o �' <br /> Filling/Grading $150 Boathouse $500 <br /> v <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. C (" <br /> C � <br /> *Communication Towers,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's Name: 3v <br /> a , <br /> Property Owner's Mailing Address: teV L44-t`Z 151W. <br /> City State Zip ^9 <br /> Property Site Address: � � lc��►c�-.iTi'�K '7F <br /> Contact's Telephone Number: 5 1 Y7(21 <br /> t7 <br /> Contact's Email: co cx,-r K r c'rA <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N 0) <br /> legible and your email provider will accept emails from the following address:GBurnettCountyWI.gov 00 J <br /> >r� a <br /> Legal Description of Property: ��'t �/ s'c3 �- 40.7-, l.��i� �-�� 5'6 e <br /> EL <br /> Section#: 00 Town#: N Range#: W Town of: 1 ' <br /> *Attach additional page if needed far lengthy description OR attach a copy of'the deed OR attach tax.system property page. <br /> 0 � <br /> Tax I D#(1-5 digit number;found on tax statement): /b-7`i3 1 d <br /> Proposed Use of Structure/Addition: _ �'f y!,'j y `-1 <br /> Anticipated Start Date: t{— �`j (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W <br /> Building Contractor: 11:5—W Sewer Installer: X06e, !C 11G!aA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> m <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Mo 40 tKc ze-cl 2 be�r�ornS Vex S - <br /> f Fee Rec:��Z <br /> SC Sys-�e,rn �QXcb <br /> VI L� I�1�a1 Check#: Z7 <br /> z <br /> n <br /> Date of staff site visit: 2- Zy �25 Initials of site visit staff:Q 't k-IG <br /> APPROVED BV LAND SERVICES OFFICIALI/ / /-� �/G� DATE: 3 7 ZOZS coo cp0rT1 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD <br /> t7 0 <br /> oa C=) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT gg <br /> CD <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 C--� <br />