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LAND USE PERMIT APPLICATION -Burnett Count r <br /> y, WI Cr <br /> e a <br /> N: b <br /> Applicant Complete All Sections Below This LineCD <br /> ' N <br /> Permit Types and Fees:Please,check appropriate boxes), ° <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk 113unkhouse $250 , <br /> Driveways/&Campground Structures 1 $125 IWI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 113oathouse $500 <br /> to t <br /> Solar Panels(Stand alone or roof mounted) 1$150 Permit Extension(1 Year Extension-Allowed Once) $100 5. <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. <br /> z <br /> _ o <br /> Property Owner's Name: jC c f 0 <br /> 0 <br /> 0 <br /> Property Owner's Mailing Address: — w n <br /> City State Zip <br /> Property Site Address: /7 G }� < <br /> o <br /> Contact's Telephone Number: z/. <br /> AM Z0 1l/(l�/ eWf /� <br /> Contact's Email: `>/�, �� , c ! <br /> **If staff has a quues ion about this application,you will be co tatted via email. Make sure your email address is ro N <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov 5. <br /> Legal Description of Property: �C� C ©Y (—Op t �/ � .� <br /> d J <br /> Section#: 2S Town#:_ �_N Range#: 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.* v� <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement):�7 /� ►J <br /> /� <br /> C7 <br /> Proposed Use of Structure d' io • A dI <br /> Anticipated Start Date: j <br /> Z ome/Cabin;Commercial Business;Bedroom;Deck;etc.) J <br /> z -C <br /> Building Contractor: Sewer Installer: y 0 O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> 0 De� ►mZ4 wU�-A- au St4XLL, S <br /> n Fee Rec:I a5 bo <br /> z Check#: O <br /> a <br /> a <br /> v <br /> Date of staff site visit: ZOZS Initials of site visit staff:`'r\,L:)l luul <br /> �j,,, � � ,�,� , <br /> APPROVED BY LAND SERVICES OFFICIAI>.q l� DATE: 7 Zv25 b T <br /> o c <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF L Y <br /> Q> C� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 ��-� <br />