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LAND USE PERMIT APPLICATION --Burnett County, WI roci <br /> Applicant Complete All Sections Below This Line ' c <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> C7 � <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.) $�o Addition/Alteration to Accessory Structure $150 �U\ <br /> � g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) VVV <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 /> Solar Panels(Stand alone or roof mounted) 1$150 Permit Extension(1 Year Extension-Allowed Once) $100 5!. <br /> NOTE:After-the-fact permits it acquired after construction has ba un u to three times the normal fe <br /> ro <br /> mmunicotion 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: /TU' " <br /> a I <br /> Property Owner's Mailing Address: -7 _-5 <br /> ( City State Zip <br /> Property Site Address: .� e�C� C)�c� 3� i btN 8 1_)C 1r � :O c N <br /> CD <br /> Contact's Telephone Number: <br /> ,, )-- C,Q d <br /> Contact's Email: �—t L)M (-A S <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 /> Legal Description of Property:C,P4�1 Oc ij l7 1 lu f4 S -T CS✓4,� i,5,j y V j3 P?0 � d - <br /> Section#: Town#:T ©N Range#:RUto-_W Town of: 0 1°< i� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> C a <br /> Proposed Use of Structure/Addition: ¢'► -� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) oP <br /> x _ <br /> Building Contractor: Cm.1 Sewer Installer:JqD P K t I4--f � � • � <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> M <br /> No} �o he 4r human 6,b�4v,+ y <br /> Fee Rec <br /> 0 <br /> z Check#: <br /> z <br /> M <br /> m <br /> Date of staff site visit: ZDZ Initials of;s' e visit staff:9 e 4- <br /> 2 n � <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 3 Z S T t <br /> 0 m --4 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C <br /> Cn <br /> CD <br /> C7 C�'t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 ..�. <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />