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CD <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and FeestP/ease,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 /> n <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 /> b <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: PC <br /> Property Owner's Mailing Address: C 0. E $T Aj EV) 1 0i1,�,> j SyUC / <br /> City State Zip ° <br /> Property Site Address: 11.39(o 1`latj„,6<//' Leyye o <br /> Contact's Telephone Number: <br /> N d <br /> II__ <br /> Contact's Email: A *, lr� c <br /> **If staff has a questio about this application,you will be contacted via email. Make sure your email address is b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 00 <br /> n a' <br /> Legal Description of Property: L�( 1 CSM 5-i6K M- �)e 1" ab3 d N <br /> s <br /> Section#: _Town#: N Range#:__RL�—W Town of: SWI S_5 <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> ✓� <br /> r� � o � <br /> Tax ID#(1-5 digit number; found on tax statement): �3 N <br /> d <br /> Proposed Use of Structure/Add'tion: G14 A6F ToAAGI= � <br /> Anticipated Start Date: (o I (Home/Cabin;Commercial Business;/Bedroom;Deck;etc.) <br /> Building Contractor: � CZ6- Sewer Installer: & A N � � � <br /> co <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o �, C° <br /> Q CA <br /> MOZC— Au— 5eT3ACILS <br /> d z tvo-r -ro OG U,5eea fop. ti0KXA,\) 0AOIT-�+TWO <br /> 3O 5T'OR66f CaA)tw)Av6R TC 8� REncoV6�J oR AktrTTFD 8`! �/t/2o25. Fee Rec: 15D. OD <br /> z Check#:10 7 9(D <br /> r <br /> G <br /> z <br /> w <br /> Date of staff site visit:51-Z2. Initials of site visit staff:j—_)j3 <br /> CDK CD W <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 DATE: z �3jRo2S <.3 r <br /> CD <br /> n co ll tf <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD a <br /> Url <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />