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Jerre I c,,PPxi)ved P4 <br /> CD <br /> LAND USE PERMIT APPLICATION — Burnett County, WI F <br /> a <br /> <' b <br /> Applicant Complete All Sections Below This Line 7 c c <br /> Permit Types and FeestP/ease,check appropriate boxes) n <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C, <br /> 0 \ a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> X IDriveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r N <br /> U <br /> Filling/Grading $150 Boathouse $500 <br /> w <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 /> ro <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 /> z <br /> O <br /> Property Owner's Name: C/o-a d-et GU 1'ei l,f o kA <br /> �'S6 ��6f� -S' Nu MA) <br /> Property Owner's Mailing Address: d. v <br /> /� <br /> 'ity State Zip <br /> Property Site Address: a, l 06 j0aig hots Lake, /V Ji r-eii w.Z M. gvpIN � <br /> o c <br /> CD <br /> Contact's Telephone Number: <br /> Contact's Email: T ifek7 l All d-r ih <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N o <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov 0 � � <br /> Legal Description of Property: PL L G'O y L(/ L y d No <br /> Section#: Town#:-j<F N Range#:17W Town of:40WI �f <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> C/ o <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> dock- <br /> Anticipated C7 <br /> Proposed Use of Structure/Addition: Aepx/ cl 4 wad <br /> Start Date:OC* 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x <br /> Building Contractor:seti -S L0.tl CaPtn Sewer Installer: CD <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° -- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o L <br /> Q Mi£ET 6-I DE 516-1 .S p <br /> © nbT- 76 0<6efl 5 FEET Wl DTH, m <br /> T�IIs �t�kicT' IS Fog, SrBpS 'Ta r ja tr noGk pn L�l. �� <br /> n Fee Rec: <br /> z Check#: <br /> r <br /> C <br /> r <br /> o CIO <br /> 2� Initials of site visit staff:m m rTi <br /> Date of staff site visit: � ` <br /> APPROVED BY LAND SERVICES OFFICIAL: ( DATE: 9' �g Za2S m ` o <br /> rn <br /> o 00 <br /> UPON APPROVAL: APPLI NT ST POST COPY OF ''3 Ln <br /> C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 ------------ <br /> Burnett County, WI Land Use Application—Rev 07/2025 <br />