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Oked a CCPT a two '-6 65.L In <br /> LAND USE PERMIT APPLICATION - Burnett County, WI ct <br /> a It <br /> Applicant Complete All Sections Below This Line 0' y N <br /> Permit Types and Fees�Please,check appropriate boxes), ° <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � v <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 /> M <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> ti <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 /> 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: M Ae_ A-64A, <br /> 0 <br /> a. � <br /> Property Owner's Mailing Address: � w. n <br /> 1 City State Zip `" <br /> Property Site Address: '�� z(pt.l�"� l �O/r`� o N <br /> Contact's Telephone Number: l Z- f/' 5 jt-b CD <br /> a � d <br /> Contact's Email: fD <br /> **If staff has a que n about this application,you wi e c ntacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov °Q <br /> Legal Description of Property: l V d <br /> Section#:Soq Town#: _N Range#: W Town of: 11CL <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): -4 d <br /> Proposed Use of Structure/Addition: 6a� N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Cho <br /> Building Contractor: �� Sewer Installer: �� y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z �0 <br /> v <br /> I�e�-I al Sekbr,�c.�s LA <br /> ® Nod--b �k W -�� L <br /> 3O Fee Rec: J .�� <br /> zrVJJDGj CU etU VZwu-n�- Ot Check#: a'S <br /> Ave~+ , 0o'on 2: 213 . <br /> Date of staff site visit:5 S5 Initials of site visit staf: 3 Q <br /> APPROVED BY LAND SERVICES OFFICIAL`:_ DATE: `J LO Z®ZS m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �} <br /> CC <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT LA <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />