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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> .. N <br /> Applicant Complete All Sections Below This Line 0 <br /> a. <br /> Permit Types and Fees:Please,check appropriate boxes) C7 <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ p <br /> � f <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 M <br /> M <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <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 /> CD <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: iq S " o <br /> /� ' S c . a <br /> Property Owner's Mailing Address: 1 -S 3 3 6 FL OW,'R �,(,�rr I a l �` �Z a' n <br /> {� City State Zip <br /> Property Site Address: _3C Z i b12 V V°^ v((��/1.Nl ACi� D17A 6ur�/. W�• S`/�3n <br /> C� <br /> Contact's Telephone Number: 1;.S I -3 S 3 0 / _3 <br /> f I N d <br /> Contact's Email: c�S i'1 �I I'- 5 I� G mcz I• G�%4t'L <br /> **If staff has a question about this 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: @BurnettCountyWI.gov IQ <br /> d <br /> Legal Description of Property: <br /> Lo 'f CSM y9q `7 w <br /> Section#: Z (�' Town#:�N Range#: W Town of: S(c>/S—� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): -3>c�/y Z 2— w <br /> Proposed Use of Structure/Addition: -54n r[t trip / Sh,l9,o ino 6 , �.I�/'ur^ " -� F. W <br /> Anticipated Start Date: (Home/Cabe Comi ercial Business;Bedroom;Deck;etc.) v, <br /> Building Contractor: Sewer Installer: y N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> Cn <br /> S�- r�S < <br /> 0 IV04 -� be use � h�� huh►-�� , S-���� <br /> m <br /> On I^ ( Fee Rec: <br /> r o �D �t-h'LOVf c� J 1 t l I2025 z Check#: <br /> a <br /> < r � <br /> �^,NN m p� U �Lt <br /> Date of staff site visit:5/�3�2025 Initials of site visit staff�C� m W <br /> aCc�k �sil� �s <br /> APPROVED BY LAND SERVICES OFFICIAL. �� DATE: `J L,202 a o <br /> Cn c) co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 10= o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />