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LAND USE PERMIT APPLICATION—Burnett County, WI I b <br /> Applicant Complete All Sections Below This Line <br /> Permit types and PeesfPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 /> x Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(Sv)Structures $350 S <br /> Filling/Grading $150 Boathouse $500 �~ <br /> Solar Panels(Stand alone or roof mounted) 1$150 Permit Extension(1 Year Extension-Allowed Once) $S00 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> v <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> 0 <br /> Property Owners Name: pA / 0 N <br /> I 1� <br /> Property Owner s Mailing Address: 3 P `S P JIB►' (w� �7 8�3 „N,p <br /> 6363 P�4'J P�, city State Zip �- <br /> Property Site Address: u1,o�j_�t �N�f o <br /> Contact's Telephone Number: 6 rZ "32Z-g�j <br /> d <br /> Contact's Email: /t L,,A—o, k n 4Q &o -cep*x <br /> **If staff has a queofion stout t1fis application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: urnettCountyWI.gov °• �° <br /> Legal Description of Property: ?CL 1J Uj SE S F 6-F5 <br /> I <br /> Section#:Z_Town#: N Range#: I k W Town of. /16e d 0 d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v� <br /> Tax ID#(1-5 digit number,found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> iN <br /> Anticipated Start Date: 1140 (HomelCabin;Commercial Business;Bedroom;Deck,etc.) IQ <br /> � ilu <br /> Building Contractor: Sewer Installer: y Q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: > <br /> 10t� aU 'e-4a S ;10 <br /> b�af Shed � cargo [�n-I-a.(n,�-� need a � USA Perm i-� by U t 2615 <br /> 9 Fee Rec: I As.00 <br /> z Check#: (?L <br /> r <br /> K <br /> C� <br /> til <br /> Date of staff site visit: �7 �Z5 Initials of site visit staff. Q D [�f <br /> Cn o' <br /> APPROVED BY LAND SERVICES OFFICIAL �. �(/10 DATE: q ZZ ZpZS � _ � <br /> E CCD O <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF cn <br /> o o co 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT s <br /> Page 1 of 5 r; <br /> Burnett County,WI Land Use Application--Rev 11/2024 <br />