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LAND USE PERMIT APPLICATION—Burnett County, WI C b r <br /> < b <br /> Applicant,Com Iete All Sections Below This Line cn <br /> a <br /> Permit Types and Fees fPleose,check appropriate boxes);id \ <br /> Dwelling/Principal Structure $300 'Addition/Alteration to Dwelling/Principal Structure $200 U� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> M <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <br /> v: <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 /> v <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 /> _ ° <br /> Property Owner's Name: / � M o0011d CITY( <br /> w <br /> Property Owner's Mailing Address: <br /> City States <br /> :Property Site Address: 505V &?zdG- Z. <br /> Contact's Telephone Number: <br /> Contact's Email: P 1 uft) ;S 5c) P' pm,�' t d)► , Ct <br /> **lf staff has a question about this pplic ion,you will be contacted via email. Make sure your email address is N b 'C <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov ° °0 <br /> A / / 9' v <br /> Legal Description of Property: 4bir" f 3 SAV^• 1 �P d ...o <br /> Section#: x9 Town#: yy N Range#: ! W Town of: <br /> *Attach additional Rage if'needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number; found on tax statement): 6-F7 r7 N a <br /> Proposed Use of Structure/Addition: A��� �1� q <br /> Anticipated Start Date: '� /y (Hane/Cahin;Commercial Business;Bedroom;Deck;etc) � <br /> -Z! <br /> Building Contractor. Sewer Installer <br /> AREA'BIJ O� THIS'I;11VE'FOR LAND`'SERVICES ST'AI bMME1VTS/CONDITI6IVS`6 ' z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ; <br /> �uS+ X, U� <br /> Yv1e t✓-�- a� S.e,-4-�oa�s <br /> DWCLW-tj nth-+() t Y.(eed 1Qe�►'°flm p.e r Srin� <br /> a <br /> r' Fee Rec:� <br /> 30 Farfe I i S a+ 15% Impvvtau-s SLA r-tact , any �u-h t,re (mpruvtyKP.VL-71.S Check#: <br /> ��� re�ui✓2 vn�+i5f�,-h� <br /> Date of staff site visit: Ini 'als of si visit staff. L7 = n <br /> fl y> 11 t1�I <br /> APPROVED BY LAND SERVICES OFFICIA �MllhWdM� (f DATE: d S m0 CD <br /> cW <br /> UP(3Nr �FFRfJVAI� F APPIICAN �NIUSTPOSTGOP1' OF o o [tit <br /> SIGNED PE Y ' A�P1 LI IOI T � IN IGHT <br /> � e r <br /> Page 1 of 5 `° �J <br /> Burnett County,WI Land Use Application—Rev 11/2024 � <br />