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� ro <br /> LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> a b <br /> Applicant Complete All Sections Below This Line a v <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 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 <br /> n b T <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 1 jWl State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 1 18oathouse $500 <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. <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form,see corresponding application,and fees. (a <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: C HA i) A*o MELT Js A yA y-46 - o Z <br /> a <br /> Property Owner's Mailing Address: 1�_Co oAN=,►6 Sire dx <br /> City State Zip ° .0 <br /> Property Site Address: q.0 1 /Mo4e-. ,-ens A7-4 X DEC OANav to wz o <br /> Contact's Telephone Number: 6 S( - T 7 r- 7 7 <br /> N v <br /> -o <br /> Contact's Email:L 61A,g y9CA q,&,s ; r c-J <br /> **If staff has a question about this applicat n,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: @BumettCountyWI.gov °O <br /> L oT . <br /> Legal Description of Property: IQ�SS/�E.�+i T�yC /a��^+� FaX/IZOG/a �400 V!! 7-� <br /> Section#: S� Town#:__Yo N Range#: (S' W Town of: 3A GlC,S u.✓ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v� <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): 3Sr^) p g <br /> o C7 <br /> Proposed Use of Structure/Addition: (,AAA grz .a <br /> Anticipated Start Date: , 'u✓''� 2v Ls� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) i l <br /> Building Contractor: Sewer Installer: y � � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> M <br /> lJ MC-ET- ALL— 5tE-13AC CS. <br /> M <br /> m <br /> Fee Rec:� <br /> °z Check#:?D27 <br /> r <br /> z ------�� <br /> m 7�7 <br /> Date of staff site visit: 3I!���ZS Initials of site visit staff:!J� 4- a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 2 0 5CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a r iJ U U <br /> -0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> Page I of 5 <br /> Burnett County, WI Land Use Application-Rev 04/2024 <br />