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LAND USE PERMIT APPLICATION - Burnett County, WI ro <br /> a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and FeestPlease,check appropriate boxes) <br /> C7 ` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300rMnSlithate <br /> on/Alteration to Commercial/Industrial Structure $200 "� O <br /> Accessory Structure(Garage,Shed,etc.) $150on/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200on/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $250 ° <br /> Driveways/&Campground Structures $125 Statute 59.692(ly)Structures $350 " <br /> r <br /> 0 <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> z <br /> _ o <br /> Property Owner's Name: rn i (� ��) 5� 1�►�k� o N <br /> Property Owner's Mailing Address: <br /> � <br /> City State Zi vn, <br /> Property Site Address: 2 /1 1 32- weSt— (AVM YJQ 1-iT 1{, ie� tt;l 511 j�t.� Z N <br /> o c <br /> Contact's Telephone Number:`;SV',DM,67s- v -715 —5(96'Z 4 3 <br /> Contact's Email: b r—Ck e-�eQSDVI, W1 d L.D Kj <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov <br /> Legal Description of Property: G0 i, L("jT T 119 'S$ d p <br /> Section#: 3 J Town#: qn N Range#: 16 W Town of: pAr LAV-lb <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7 <br /> 73 <br /> o <br /> Tax ID#(1-5 digit number;found on tax statement): 13 c1 N c►a <br /> r _ _ d <br /> Proposed Use of Structure/Addition: 7 A"A l 5�-0 L 4S t I AA A A 6►QV <br /> Anticipated Start Date: P1Q1k �z© Z 5 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> _ a <br /> Building Contractor: �L' �(AQ �1 �a St 1i Sewer Installer: rl.+ o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> v � G <br /> QQ rv►EEr ALL SE tRACkS z <br /> Q2 NOT TD at dU�D Fog, (;}VnnAAJ 14•g31rAT10N, M <br /> ® f:;U a 1►uPEIZvIouS AURP,4CE <br /> Fee Rec: <br /> °z Check#: <br /> r- <br /> C <br /> z <br /> W [n <br /> Date of staff site visit: �, (n tJ a lJ <br /> Il 2,�j Initials of site visit staff:� <br /> me � <br /> 2.3 <br /> APPROVED BY LAND SERVICES OFFICIAL: ( DATE: j3 az 5- y » c <br /> UPON APPROVAL: APPLICANT ST POST COPY OF <br /> to <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 07/2025 <br />