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LAND USE PERMIT APPLICATION—Burnett County,WI a b <br /> Applicant Complete All Sections Below This Line to <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> d <br /> Dwelling/Primipal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> G) C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <. K1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 o U1 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o � <br /> Property Owner's Name: d I t/] <br /> h� �i ►� <br /> Property Owner's Mailing Address: j q C C`0(� <br /> O � I n�e�5/-amity, ,,_ State_G Zi < <br /> Property Site Address: W f�' �,Ll� 0 o y <br /> Contact's Telephone Number`: <br /> Contact's Email: Kell Jl 1r1 o e l -- & G Yea I ( � <br /> **If staff has a question about this application,yo ill be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov °C N <br /> Legal Description of Property: L�T c5 m V a i d G�W Lck 0 �u 3 0 d o <br /> Section#S-A(Q Town#: 1 `-1 Range#: W Town of: lam($I <br /> *Attach additional page if needed_for lengthy description OR attach a copy of the deed OR attach tax system property page.* as <br /> Tax ID#(1-5 digit number;found on tax statement):_ `1 <br /> a C7 <br /> Proposed Use of Structure/Addition: r,OL <br /> Anticipated Start Date: (HomelCabin;Commercial Business;Bedroom;Deck;etc.) <br /> H <br /> Building Contractor: r Sewer installer: lv <br /> 5 � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY to z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i <br /> no4 -b tY-c f ed <br /> O3 '✓Y Hof -ft tyaeJ W4 ►tX.i�1+ Feeltee:—�00,00 <br /> ✓y`tv " Z Check#:2 <br /> r <br /> K <br /> l) ^ <br /> O m U Y <br /> Date of staff site visit:3�lo 1?--Jr 3221 12.E Initials of s' visit staff: ULS e- Tt n <br /> tT? O!/ <br /> APPROVED BY LAND SERVICES OFFICIA a ATE: / Z XZ5 ?.m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> m c IV \l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 9� <br /> 3 <br /> Page 1 of 5 <br /> Burnett County WI Land Use Annlication—Rev 11/2024 <br />