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C r <br /> LAND USE PERMIT APPLICATION"— Burnett CountyWI a _ <br /> < b <br /> � N <br /> Applicant Complete All Sections Below This Line <br /> a. <br /> Permit Types and FeestPiease,check appropriate boxes) C7 <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `? <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c �\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r lJ <br /> Filling/Grading $150 113oathouse $500 L <br /> Solar Panels(Stand alone or roof mounted) $150 IPermit 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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ° z <br /> 0 <br /> Property Owner's Name: <br /> /� nA o. t <br /> Property Owner's Mailing Address: '"T <br /> �7 ��p �jj� City State Zip <br /> Property Site Address: L ��'�_5dl Li 1 V —____ z o <br /> Contact's Telephone Number: <br /> Contact's Email: Q( <br /> **If staff has a question about this a placation,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 2 °Q e <br /> Legal Description of Property: p t7 <br /> MPBVADN N <br /> Section#:�Town#: N Range#: W Town of- <br /> *Attach additional page if needed for lengthy description OR attach as copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 'I I/ 1 4` x <br /> Y o <br /> Proposed Use of Structure/Addit'on. 1 S a <br /> Anticipated Start Date: (HomelCabm;Commercial Business;Bedroom;Deck;etc.) p„ <br /> Q ,��otn,{� �� � N <br /> Building Contractor: � Sewer Installer: � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> m � <br /> Qi AF6r ALL JET81961CS. < <br /> n <br /> zU ,per -0 FE 09EP Foe t4UKAAN HAD/T9TlonJ g <br /> Fee Rec: <br /> ° Check#:2-UL 1F <br /> r <br /> m <br /> • n <br /> m <br /> o <br /> Date of staff site visit:71IS176 4� 712111(zs Initials of site visit staff: <br /> � 5 � a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:_TZ.p�s c�00 C <br /> A <br /> UPON APPROVAL: APPLICANT UST POST COPY OF <br /> Do � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ Q <br /> Page 1 of 5 CD [jam <br /> Burnett County, WI Land Use Application—Rev 11/2024 C�-7� <br />