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LAND USE PERMIT APPLICATION — Burnett County, WI En 10 <br /> Applicant Complete All Sections Below This Line ' N <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> C7 <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 p"\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �� R <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° (Nn <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 o v1 <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 c�, <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 /> o <br /> Property Owner's Name: aA C y o (� <br /> Property Owner's Mailing Address: Am < &(nW&v4 <br /> City State Zip <br /> Property Site Address: -e,'n ah W 1 36 glWir- o <br /> LLlU t 0� /►16 ?' <br /> Contact's Telephone Number: - 6 �vZ - �6�C�' ° <br /> d <br /> Contact's Email:-�0-0 t c_a- f Y ► `��OS�`-� �� y l<1 UV•e 0o <br /> **If staff has a question about this application,YoU will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °Q <br /> S <br /> Legal Description of Property: 1)wjl<<d S u b L or 3 d <br /> f^/a <br /> Section# - "4 Town#40j7N Range#:_/ Town of: � �Kr <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> p ° <br /> Tax ID#(1-5 digit number; found on tax statement): fo�locp — J <br /> Proposed Use of Structure/Addition: n _�, L .� <br /> Anticipated Start Date: M 4-kj S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x S <br /> Building Contractor: Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m N <br /> z � 6` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o l� <br /> 0 nroT to 13t US*(D fO2 t4Ui;Artnl H,9C�I7ATloN, <br /> © SEE rrr+ctiED c ETT E►Z FQo" NE16*t-t30 k . 01C wt rif STRv 0TV1? & <br /> SEPTIC- TgNW_ UP M aE 6ECWZL713 FeeRec: I <br /> °z Check#: 2-11� <br /> r <br /> a <br /> m <br /> n <br /> 13( 2525 Initials of site visit staff: a v '^` <br /> Date of staff site visit: .3 E <br /> APPROVED BY LAND SERVICES OFFICIAL: - DATE: 5 2o?r500 <br /> i 0 <br /> op <br /> UPON APPROVAL: APPLIC NT 4ST POST COPY OFF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °° <br /> U <br /> 7 <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 04/2024 <br />