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• LAND USE PERMIT APPLICATION —Burnett County, WI ro <br /> N Applicant Complete All Sections Below This Line N <br /> Permit Types and Fees(Please,check appropriate boxes) 5_7 e <br /> G <br /> Dwelling/Principal Structure $300FAdd <br /> tion/Alteration to Dwelling/Principal Structure $200 nC <br /> Commercial/Industrial Structure $300Addition/Alteration to Commercial/Industrial Structure $200 \_ \p <br /> Accessory Structure(Garage,Shed,etc.) $150tion/Alteration to Accessory Structure $150 <br /> a M <br /> Accessory Structure(Commercial/Industrial) $200tion/Alteration to Bunkhouse $150 <br /> G) O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk khouse $250 <_ <br /> 40 <br /> Driveways/&Campground Structures $125tate Statute 59.692(1v)Structures $350Filling/Grading $150house $500 <br /> Solar Panels(Stand alone or roof mounted) $150it 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. o <br /> z <br /> Property Owner's Name: r/. S " <br /> ,.._. GL �- cU <br /> Property Owner's Mailing Address: S D cs fd-1Y1 C i rG u,,1k / / ✓T �. <br /> City State Zip K <br /> Property Site Address: 4Z d l/Bt I W,4 �' 9 0 <br /> a <br /> Contact's Telephone Number:: <br /> Contact's Email: aN Lj� A G-j L o� <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov <br /> B/BurnettCoun..{tyWI.go`v� 5 °° W <br /> Legal Description of Property0 j/e//4 A) f /U VG'Y �'f�;/%e 1 d <br /> Section#:7 —Town#: N Range#:1 e� W Town of: c�{s�{�OI^� <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 s <br /> Proposed Use of Structure/Additio <br /> Anticipated Start Date: — o ( ome/Cabin;Commercial Business;BM oom;Deck;etc.) ,C <br /> Building Contractor: se �' Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> m <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> -For CL c�► ct ors lY , c u n n o-� be U�e cl�� �I u n't�.�-, 0-OD <br /> 1_� Fee Rec: <br /> GI�D I+Ck-�l On � <br /> nAru�C�SNI z Check#: <br /> a Ce - td &vvet3fctS55S� 40 he CD ntibi vied lam <br /> ff)6 ra�f,Q p lwr b;n9 4t sae Co n n e(.-fie cl 40 2 x S h <br /> // L2-DZ5 Date of staff site visit: 51,3 Initials of site visit staff. G <br /> APPROVED BY LAND SERVICES OFFICIAL i ��./�s%�/�"/� DATE: s Z3 �ZS ro m w <br /> - 7 <br /> G <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD <br /> a � <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 �� <br />