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LAND USE PERMIT APPLICATION—Burnett County, WI e <br /> Z. b1r <br /> Applicant Complete All Sections Below This Line �1 <br /> Permit Types and FeesiPlease,check appropriate boxes) <br /> a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> c� 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � \ <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 fn <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 S <br /> Filling/Grading $150 113oathouse $500 <br /> Solar Panels(Stand alone or roof mounted) 1$150 1 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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ^bT' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> z <br /> 0 <br /> N <br /> Property Owner's Name: 52.n j0. V�,,^ QnCA CrT,g4M `� G C06.5 � W <br /> for SNP � ry <br /> Property Owner's Mailing Address: 2 a e. <br /> 3 60'2 C 4 51 City State Zi 0 <br /> Property Site Address: ov VW f^Q, �c- , L7an}JU/�i w� 5�l 3� C y <br /> O y <br /> ' Telephone 2IF 3q! i;3o8 °Contact's Tel hone Number: <br /> t Contact's Email: dI <br /> **If staff has a question about thistapplication,you wAl be contacted via email. Make sure your email address is ( .d <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov 00 <br /> -a / <br /> Legal Description of Property://�s`xiSS �-, 5? �► <br /> Section#: 2 Town#: 1 U N Range#: Town of:� t�_ N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> r o <br /> Tax ID#(1-5 digit number;found on tax statement):u $O <br /> Proposed Use of Structure/Addition: O 4A►'l lq a <br /> Anticipated Start Date: (Home/C bin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: C� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1 � <br /> rDItuj L4i0nS ( 1—ve-c. 8 �Im PuvlDAts Sim4au% )�rtz".'+, y <br /> recbr&&4 LYl q11S jZ,pZS Fee Rec: <br /> 0 Check#:q1,23 <br /> m <br /> Date of staff site visit: -7 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFIC DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CD r- <br /> Co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 25 CD <br /> N <br /> 00 <br /> Page 1 of 5 a � o <br /> Burnett County,WI Land Use Application-Rev 12/2023 <br />