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LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> Applicant Complete All Sections Below This Line r! <br /> a <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `\W <br /> Accessory Structure(Garage,Shed,etc.) $150 -N Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk 113unkhouse $250 <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(iv)Structures $350 0 <br /> Filling/Grading $150 113oathouse $500 G <br /> w c'� <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R. <br /> NOTE:After-the-fad permits(permit acquired after construction has begun)may cost up to three times the normal fee. <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 /> Property Owner's Name: 7 1`\C7737 �" W <br /> Property Owner's Mailing Address: a cs+ � _=. <br /> � <br /> / _ w <br /> Property Site Address: �c/D1 I ` ��,r City VT St t -j CA <br /> • <br /> Contact's Telephone Number: i I�'� I IC J <br /> �� " 11 COM <br /> Contact's Email: �C W ce �U* ,(-1A� h_( �� ��h <br /> **If staff has a question about this application,you will be contacted via email. Make sure y ur email address is N c <br /> legible and your email provider will accept emails from the following address: to BurnettCountyWI.gov <br /> 5' <br /> Legal Description of Property: S RWU PINa3 'WnA (N IN o <br /> Section#:_DI Town#: 0 N Range#:��W Town of: �0 <br /> *Attach additional page if needed fir lengthy description OR attach a cony of'the deed OR attach tax system property page. <br /> A o � <br /> Tax ID#(1-5 digit number;found on tax statement): i <br /> _� v <br /> - �4 <br /> Proposed Use of Structure/Addition:l5'P� <br /> Anticipated Start Date: (Nonre/Cahin;Commercial Business;Bedroom;Deck;etc.) G <br /> Building Contractor: Sewer Installer: ti <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o ._-m o Q <br /> T <br /> Q r►'Z EET A ti S�i�AcsC,S XVY <br /> � <br /> A <br /> T <br /> ZO "T 777 F3E USED Fitz tk"IA1 M/ 4"1 TF n6W 42 <br /> r Fee Rec:1 <br /> T. <br /> Check#: `4) <br /> Date of staff site visit: W Initials of site visit staff- b-6 <br /> ro Q � IJ �l1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 31 1) 1 25- m a <br /> <_ <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF o w <br /> SIGNED PERMIT APPLICATION IlN PLAIN SI_ <br /> CD <br /> Page 1 of 5 �----�� <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />