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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> N <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V <br /> F <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 !� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 CD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �, cj C' <br /> Driveways/&Campground Structures $125 1 jWl State Statute 59.692(1v)Structures $350 r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> a <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> IJiGDtE c G, <br /> � N <br /> Property Owner's Name: D01AgjA-S ` <br /> Property Owner's Mailing Address: (403ct C,02R( SER -a <br /> City State Zip <br /> Property Site Address: V4r73 ; <br /> u o � <br /> Contact's Telephone Number: <br /> �+J a <br /> Contact's Email: (All kftlo-; ' '74P <br /> **If staff has a quR ion about this application,yo will be contacted via email. Make sure your email address is "� <br /> legible and your email provider will accept emails from the following address: c;BurnettCountyWI.gov ao <br /> z CSC 5 3�5 Uot 3o P t 12cx r5 4$�FaBa.> N <br /> Legal Description of Property: �-o c< <br /> Section#: 33 Town#: tf 0 N Range#:� _W 'Town of. 0Ak,(r A-0 <br /> *Attach additional page r/needed.for length-description OR attach a coj?v of the deed OR attach tar si stern property page <br /> w <br /> W � " <br /> Tax ID ft(1-5 digit number;found on tax statement): 3e n ( C7 <br /> Proposed Use of Structure/Addition: (�:M(ZAK— <br /> Anticipated Start Date: AKA 010df"-- Mome'C'abin;Commercial Business;Bedroom;Deck:etc.) 0 <br /> Building Contractor: 5etr Sewer Installer: AJ4-- o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONtNIENTS/CONDITIONS ONLY ' J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , U 'I <br /> lO WFET ALL SETBAC.ICT rn <br /> Q AAT To gE USED fbtZ HUMAN H<i't3tT�9TraN <br /> c B`f 8 f 16�2025. y '' <br /> Q 1 IZ x 4 ioER•w'r7'E <br /> 1�bR[N '� Inc ' Fee Rec: <br /> Check <br /> Date of staff site visit: 7//3/Zo23 Initials of site visit staff: 'i�� <br /> APPROVED BV LAND SERVICES OFFICIAL: t 1 _DATE:7/x UZs CD <br /> <.3 <br /> 0 <br /> UPON APPROVAL: APPLIC NT WS: <br /> T POST COPY OF o 0 <br /> CD C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> Page I of 5 <br /> Burnett County, WI Land Use Application —Rev 07/2025 <br />