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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> a � b <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees�Pleose,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 X- C, <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 /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 o O r <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) 1$100 <br /> a_ <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro C- <br /> * <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: d�/Z/ ` + L', S �Zi o N <br /> o N <br /> Property Owner's Mailing Address: c7 S tS !� T v* �.k� s �� �{ 2 W ` <br /> City State Zip ° °D <br /> Property Site Address:'] ,C. �„a���,�,�' ��r,.t t- ( fj I.w I r w U SI/t;p ln, _ < <br /> T � o � v <br /> Contact's Telephone Number: kp 12 -10 K 1 2 <br /> e <br /> Contact's Email: -Q_C U CA IV 0 r-e i\�t M A <br /> CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is v <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °A <br /> �J rr N <br /> Legal Description of Property: Li, \i Ya ti o,6 d. <br /> Section#:5�� _Town#: g tJ N Range#: 1 lW Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v� <br /> � H <br /> Z <br /> Tax ID#(1-5 digit number; found on tax statement): I-(� ) <br /> � d <br /> Proposed Use of Structure/A dition: S o r r-4^ •� <br /> Anticipated Start Date: I (xomelCabin;Commercial Business;Bedroom;Deck;etc.) (� <br /> � 3a <br /> Building Contractor: Sewer Installer: 4. <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m° <br /> Z v r' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z M <br /> v <br /> Q MEET ALL sErBAc►(S <br /> Q A)o-r Td 9C USED Fo1Z 40WAA/ H A8tr,17 i6A) y <br /> r <br /> m <br /> Fee Rec: <br /> z' Check#: 6o <br /> r <br /> -C <br /> a <br /> m <br /> o r-- <br /> Date of staff site visit: (9116lZo25 Initials of site visit staff: -0$ a n c_ <br /> m co C �1 <br /> APPROVED BY LAND SERVICES OFFICIAL: I DATE: &/141 zo 2 5 z.a :z �J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> CD C N /J <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />