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• '��� CD <br /> "" t' (A 'L rl <br /> LAND USE PERMIT APPLICATIO urnett County, WI <br /> < b <br /> Applicant Complete All Sections Below This Line vNi <br /> Permit Types and Fees(Please,check appropriate boxes) p <br /> P :y <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 OQ o0 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> 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. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o i e <br /> z <br /> 0 <br /> Property Owner's Name: P^ Nsbr3 <br /> Property Owner's Mailing Address: Z, 2USHMB l L E Z—IVCZ i—AI L. 47 5402Z E" <br /> \ t� City State Zip <br /> Property Site Address: (nqq �8+�1�£N �IL� Ko�R, �rr.��1��1, � <br /> � o � <br /> Contact's Telephone Number:7l5- 3711 <br /> `' C7 <br /> Contact's Email:�gtn. (j..Al\1`�f gAft;I.faM <br /> **If staff has a question about this appliccTfi n,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov N <br /> Legal Description of Property: //SSG 02- `IJ IQ P-G I& PC L •60V LO-r 5d N <br /> Section#:�Town#: 7D N Range#:_J(W Town of: OAY-LAA b <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Cn <br /> Tax ID#(1-5 digit number;found on tax statement): N 0 C <br /> Proposed Use of Structure/ ition: rAg,,,� Ahh-T, EAAq^�L <br /> Anticipated Start Date: 125 (Home/Cabin;Co mercial Business;Bedroom;Deck;etc) <br /> Building Contractor: SELF Sewer Installer: WA � Q r � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6 <br /> Ybl EET All i��Tl3gCK S < 6` <br /> d Nor Tj ex(EeD 3 13E0r?0Vw5 &N-, S;W 356 48. F) <br /> 0 SE4?tom TRNW 13E .SEC,(K ice! CDu� f G4I4t,✓ aq 5/:zoZ5, <br /> Fee Rec:20 0. OD <br /> t-,Rtvq ?a BF R t►.t ceuEt> o R {�,u rrtt'v5, Check#:32-1 to <br /> Q5 czAmgcv ups.. UiutflED D%,jt:Lw/,6 CoDE) 1AXPE(.'roe- AR <br /> /jet.:S54Q4 PEO,VATT. <br /> Date of staff site visit: Initials of site visit staff. <br /> rX <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: 8 (n ZAZ b IR E C <br /> UPON APPROVAL: APPLI6ANTMUST POST COPY OF 10 o <br /> C7 0 00 � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application -Rev 07/2025 � <br />