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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> licant Complete All Sections Below This Line to <br /> a. <br /> Permit Types and FeestPlease,d+edr approprfate boxes) a <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 4� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �- <br /> Driveways/&Campground Structures $125 lWl State Statute 59.692(Sv)Structures $350 0 �� <br /> Filling/Grading $150 19oathouse $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 /> v <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as pergolas,landscaping etc. ter. <br /> z <br /> 0 <br /> Property Owner's Name: - ^' <br /> Property Owner's Mailing Address: 2.3 '(I " r ,v 1 J tt7l I. <br /> Ln <br /> City State Zip <br /> Property Site Address: b.n �cx Yl I c N <br /> Contact's Telephone Number: Z a <br /> d <br /> Contact's Email: tm 1 1 S4 annm� 'ma- C( m <br /> **If staff has a question about is applic ' n,you will t56 contacted via email. Make sure your email address is N 9 <br /> legible and your email provider will accept emails from the following address: YQ <br /> o tyWI.gov `i. <br /> SWSFEX 25/50'7�v X ,I )2qt d <br /> Legal Description of Property: ///Y�I(,3 j 3J (W� �tyl?' mil`1 13 <br /> g _I J <br /> Section#: l� Town#: N Range#: / W Town of:�c�" � <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 /> � ICS � <br /> d <br /> Proposed Use of Structure/Addition: �)ri1Q- <br /> Anticipated Start Date: _31 Vj f (HomelCabm;Comx►erci d Business;Bedroom;Decal;etc.) <br /> Building Contractor. IN A Sewer Installer. O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> Li'S <br /> m <br /> y <br /> V "L I S 6- SCCW td t..el-Q'► a IxI 9Ld &hjt�i i 67 911/2vZ5 a /a� ' <br /> Fee Rec: <br /> 0 Check <br /> -e <br /> Eri <br /> m <br /> d �— <br /> Date of staff site visit:--7 IIy)2025 Initials of s#e visit staff-411 <br /> CDr� <br /> 1) 1202 <br /> APPROVED BY LAND SERVICES OFFICIAL. U'�l DATE:? � tD a <br /> 3 i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N00 <br /> = 00 <br /> c <br /> a <br /> w ` <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 11/2024 ��� <br />