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. LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> �N <br /> Applicant Complete All Sections Below This Line V t <br /> Permit Types and FeestP/ease,check appropriate boxes), ° <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> ommercial/Industrial Structure 00 Addition/Alteration to Commercial/Industrial Structure $200 <br /> :9 CD <br /> ,Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) 0 Addition/Alteration to Bunkhouse $150 �1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r 1 <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 /> ^o <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 /> 0 <br /> Property Owner's Name: 4-SA611ie P(-4 o <br /> 0 <br /> Property Owner's Mailing Address: /3 r+c�lr n c r.cs 1 3�o72C/ n <br /> p City State Zip <br /> Property Site Address W y�0�p,`i Cog 4&,.5S ,cam F', C— Cat` o <br /> �i o 3 Sty c i!`✓ ' <br /> Contact's Telephone Number: <br /> /Z j d <br /> Contact's Email: �ti�%/�> CSC �r/►'►A . ' �-rt. <br /> **If staff has a question about t1frs application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: BurnettCountyWI.gov b° <br /> Legal Description of Property: <br /> U, z�Z, d }� <br /> Section#:1z Town#: N Range#: W Town of: ra <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): 93ff Z. �► � <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 9 ^ 1 'Zo Z-Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) J <br /> LL z N <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> �o�%W al'/ ccmla��ioXS -Cvr Vftk-2Y-'/7. o <br /> X <br /> 2 A)Of 4 be- use.4l ;r hu &n" �la�/�� �o�• m � <br /> s l bed {�'�� <br /> 3 K G G �� 7� SGL4 S cr ; Fee Rec: <br /> z <br /> Check#: 7 <br /> r <br /> C <br /> a <br /> t� �N <br /> Date of staff site visit: ? /Z,�ZT Initials o ite visit taff: _ n <br /> cn o3 D <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: el Zo 7-sl <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF O' � o <br /> ti S N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> m <br /> Page I of 5 F <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />