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LAND USE PERMIT APPLICATION - Burnett County, `VI a b <br /> Applicant Complete All Sections Below This Line c <br /> a <br /> Permit Types and FeestPlease,check appropriate boxes), <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `o00 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 t . <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 1 IWI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 1 IPermit 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. (z>- <br /> 10 <br /> G <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <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: C/7 Ot d o N C <br /> a <br /> Property Owner's Mailing Address: n <br /> �� City State Zip `" Nib <br /> Property Site Address: Sa/r1C a s ad0!/L oCD <br /> N <br /> Contact's Telephone Number: 5/)30O -Z O� Y`� -7Y -ald457 <br /> G <br /> w <br /> Contact's Email: jol-te-171W,04 /l)QI •COM <br /> **If staff has a question about this applicati ,you will be contacted via email. Make sure your email address is p <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov <br /> Legal Description of Property: /l a'g G5A1 7P,,W/1 VI /->; (GOV (0 -A! Q d N <br /> Section#: 241 Town#:_ qo_N Range#:__Lq__W Town of: ' <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). <br /> C7 <br /> Proposed Use of Structure/A it on: �,IrAAb rlrm� room)') 47166l <br /> Anticipated Start Date: / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: �(,f�/7Gr Sewer Installer: /UA x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> �IVI�c� au %4-b,ac.k-s 1L q/� X -� <br /> of <br /> eXc e� 3 ��"'1S �( Sf�-N #2�0 [-L 1 m <br /> Fee RecA00•0o <br /> ° Check#: 124(b <br /> y '-+�''v DCa-�ic� !S o� � -�'GCQ -�lcuc��Olcu�1 {�u� �'► � �f°r��'� <br /> m <br /> Ln <br /> Date of staff site visit:5 S L5 Initials of site visit staff." <br /> APPROVED BY LAND SERVICES OFFICIALA'--I V- DATE: 5 27 2025 Cl)fiu{' ca <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD <br /> 00 <br /> CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD <br /> Page 1 of 5 (�--�---_-�--�—��' <br /> Burnett County, WI Land Use Application—Rev 11/2024 U <br />