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LAND USE PERMIT APPLICATION — Burnett County, WI ar <br /> a � <br /> Applicant Complete All Sections Below This Line ' N <br /> Permit Types and Fees�P/ease,check appropriate boxes) <br /> G <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 /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)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 Owners Name: cs,V, <br /> p E Ma,11. F1 S+cif r ✓5� <br /> n a <br /> Property Owner's Mailing Address: L� C A <br /> City State Zip w <br /> Property Site Address: ((0 S YG 1 i d w R:yc t 2'I {-j wrt 01 2 v 5 K <br /> o N <br /> Contact's Telephone Number: q ao" <br /> LZ d <br /> Contact's Email: M14 S 2 ! (� /yICZ LO41 Y�� v; <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is z <br /> legible and your email provider will accept emails from the following address: @BumettCountyWLgov "0 J <br /> Legal Description of Property: 0-7"0 a z-J- 39 r Iq 2' -q c (BOG) -0 1 f 00c) /VO)'.5i: d q <br /> Section#: a 57- Town#:T3 C1 N Range#: L{ w W Town o£ i5(� W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* rn <br /> N <br /> Tax ID#(1-5 digit number; found on tax statement): w N <br /> Proposed Use of Structure/Addition: G C1 f ttL .� <br /> Anticipated Start Date:-6 Ll -� (�a�5 (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: Gi't t 5 f fJ c ,�j Sewer Installer: ­0 C <br /> tA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z X <br /> a <br /> rn EEr �� seTi3�Ck.s � � <br /> 0 4Jo-r To RE u5<rD FOR )40-4iv H-40"r4T1ory <br /> Q SEPTkc TRNW u D TO 8F SEcuREA 8'i LoUC CHgiN [3/ �f'l5�ZD 25. Fee Rec: � Z-5' �n <br /> z° Check#: 2� <br /> M <br /> O <br /> Date of staff site visit:-6/1 41Z-5- Initials of site visit staff: k;.Z <br /> b '�- <br /> APPROVED BY LAND SERVICES OFFICIAL: I DATE: ed(9I 2025 <br /> CD <br /> c, <br /> UPON APPROVAL: APPLIC T 4ST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT % Q a <br /> C <br /> Page 1 of 5 .. <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />