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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> < N <br /> Applicant Complete All Sections Below This Line en <br /> Permit Types and FeestPlease,check appropriate boxes) n <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 (J� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ o <br /> 7 <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 /> n N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)Structures $350 r <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. CD <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. r <br /> z <br /> 0 <br /> Property Owner's Name:.M ,(1 .� �+' -J C"l 1 10n- 2111�'i o <br /> Property Owner's Mailing Address:077a 11 apk'Kodt 'j5 Wcbskl-- Lor- 54M 3 <br /> _�, pit,y.�� �� State Zip <br /> Property Site AddresQ� Staff- d 5 (�e�51rr' E 1-�� C y <br /> Contact's Telephone Number: -56P40 -C95 IF, ° > ' <br /> Contact's Email:11)h 1 tf-,t0.o u i 1d er h=%-AQ FllSf"irlrlAil I • L oir) <br /> **If staff has a question about this application,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 R o0 <br /> 5 <br /> Legal Description of Property: l.0+ I CS M V-D 1 a9 ate <br /> Section#: -1:2)a Town#: !A0 _N Range#:���W Town of: CC 6 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> � o x <br /> Tax 1D#(1-5 digit number;found on tax statement): � �j N Rj o <br /> Proposed Use of Structure/Addition:hte i}S�X:OA . 4A:ee— City" (aM()SI-W_ 4(�Q W <br /> Anticipated Start Date: ! (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: h,l Sewer Installer: 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> OL i d x l 2 S KeA 0-*\-A 0.. Q, x�14' d¢,C-k-,. <br /> m <br /> vM Fee Rec: ( io <br /> °z Check#5-4-.9-5q <br /> 0 <br /> < <br /> o <br /> Date of staff site visit: 0�PO r Initials of site visit staff: <br /> Q����� a <br /> APPROVED BY LAND SERVICES OFFICIA> VWl0. &" DATE:?—,R9 -a J� _ ro m c� 3 <br /> Ti <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF wcm <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C <br /> CD <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 07/2025 ��� <br />