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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> a <br /> < b <br /> Applicant Complete All Sections Below This Line ' &� <br /> PermyTypes and FeestP/ease,check appropriate boxes) <br /> LI-IDwelling/Principal Structure $3001 Addition/Alteration to Dwelling/Principal Structure $200 G <br /> Commercial/Industrial Structure $300 1 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 1 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk 113unkhouse $250 <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(ly)Structures $350 r 1 <br /> Filling/Grading $150 lBoathouse $500 <br /> oc <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 /> 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 /> z <br /> 0 <br /> Property Owner's Name: C, IiA MAV <br /> o W <br /> Property Owner's Mailing Address: W / / �� E. n <br /> City State Zip <br /> ® ° lq <br /> Property Site Address: U r/� L Kf kc/ o N <br /> Contact's Telephone Number: ✓�Jt d �( � 9 6V ° <br /> C7 <br /> * L•Contact's Email: i,ke(„�7�a� �,� . Ge„.y <br /> If staff has a questio about is applica n,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: @BumettCountyWI.gov °Q N <br /> 5 � <br /> Legal Description of Property: d o <br /> N <br /> Section#:- Pf _Town#: N Range#: 17 W Town of: r T w <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> /gy <br /> Tax ID#(1-5 digit number; found on tax statement):�(/ p/ Vt 7 d <br /> -° <br /> Proposed Use of Structure/A- d' io 3 <br /> Anticipated Start Date: o29 (HomelCobin;Commercial Business;Bedroom;Deck;etc.) P- <br /> V _ <br /> Building Contractor: Sewer Installer: f�D �'/ S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r m z T W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> v <br /> QQ T ALL LL 5ETS"VC S m <br /> ZO [, ujcu. "Jor �llaT T� Cxce-c> -rWo ZE'ARoOwIS �R 5�-23-1l03, n -J <br /> A <br /> m <br /> d Cj9RgGE 5'@ RACr� N S O-r Ta c 05Ec Fo R FW no-v. to <br /> j;ra Fee Rec: <br /> © �DPmon/ Tn S7}ZvcCV14e �CC9N-TDB ?i1 81cR �r7�D $�/ /►/zo25 � <br /> ° Check#: <br /> z <br /> r <br /> m <br /> < ' <br /> Date of staff site visit:2 -7L2015 r`I S LS Initials of site visit staff: 06,�- )e(j <br /> 11 u!1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: y 2t 2ozs ' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o ;v <br /> SIGNET) PERMIT APPLICATION IN PLAIN SIGHT ' <br /> .3 C71 <br /> Page I of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />