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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line t <br /> Permit Types and FeesfP/ease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 U O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> M <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $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 /> CD <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 /> o ' <br /> Property Owner's Name: 2 cl '6 r2r1 I f1 �'PI S o �1 N <br /> I" b o <br /> Property Owner's Mailing Address: c�5 S a d 3S +r U/ <br /> City State Zip ° 4 <br /> Property Site Address: <br /> O y <br /> Contact's Telephone Number: �� 0 <br /> 0 �/1 — C7 <br /> Contact's Email: �SI�I-E e (4-t f 0. COC©r r r <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is b <br /> legible and your email provider will accept emaill!s from <br /> Athe <br /> /following <br /> address: @BurnettCountyWI.gov g b0 <br /> Legal Description of Property: <br /> Section#: pc Town#: 39 N Range#:_�W Town of. /{ /� 3' CIO <br /> �0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 2 NOH <br /> Tax ID#(1-5 digit number;found on tax statement): ) A 0 a 3 0 <br /> Proposed Use of Structure/Addition: G a MQ + S�v ra y <br /> Anticipated Start Date: b (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: 111 AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z o N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z Z w <br /> m <br /> G rneG'c FX-�- JETBAEKS < <br /> O A)oT Ta BE USED foR +SvmA,,j HABITATtbitl, y <br /> SE - ?fib AITActie�- <br /> PERA u r t-rp b 1 20 Z 5 � Fee Rec: <br /> D �° <br /> ° Check#:'>XJ/ <br /> 2C�z..S, z <br /> �u tl p),�t t- S�PT/C SEWER LJt?t+ f IZoZrSFp <br /> v m <br /> $u l l_O I N&- 4-0 t:A-h O nl. < <br /> v 0 <br /> Date of staff site visit: 3 25 �j 3 I r5 Initials of site visit staff. d- 9 > -' <br /> 3 <br /> 10 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 40 Z.o ZS CD <br /> me � D <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD a <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT K <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 �j <br />