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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a- rn cn <br /> Perm t Types and Fees(Please,check appropriate boxes) a Z. <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 IN <br /> IO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 , g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \' <br /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 —r II <br /> 0 <br /> Filling/Grading $150 Boathouse $500 N `m'� <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 1 <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o —. t b <br /> z <br /> 0 <br /> Property Owner's Name: ��.A., i[cver- j.-`ch.,.- a ^ <br /> Property Owner's Mailing Address: G a so ,,,-i j- eA, Sit,-. L S415.nA I. i <br /> ` City State Zip ° n O,O <br /> Property Site Address: c of gas l�cr�-Ct 2 , '3 . S�$-7 < y A <br /> Contact's Telephone Number: / a ' ' 1I S 6 - Q 7S's <br /> FI <br /> Contact's Email: I r c e C'rl Qicclhcx) . LC.nrl <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: @BurnettCountyWl.gpv SE V 44 = ao <br /> ,se rLegal Description of Property:'S3+c I Io rpd,.S cc-44"te_ tO .--.43 i rZ ,e z .a.1 g. <br /> Section#: ai Town#: 37 N Range#: I —1W Town of: O(\ rt.1 r S -t'3$N Qll 0 <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.*P8 .r f 8Y P Y P P YP8 � �, o � <br /> Tax ID#(1-5 digit number; found on tax statement): a3&-} y g 5 <br /> Proposed Use of Structure/Addition: r a d2..-kic„.\ V-vir 'e <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> a <br /> Building Contractor:Zcy-t LG��r Sewer Installer: i''Wo Cgr-l5-1'v") U, \o;) s <br /> o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rn <br /> VV <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> 0C i 7La0. ; :- ,4 6 ttvl ItP rf w <br /> /UC7 710 exc eez,/ C to e-a roo k—is per saw "fey y PerM/f <br /> SA/V —ZS— 8 Fee Rec: CO <br /> ° Check#: 7 /„'j <br /> z <br /> r <br /> -C <br /> Rl 1 <br /> — <br /> 00 M <br /> coo -n <br /> Date of staff site visit: )p/7/2I Zc- Initials of 'te vis' 7/0/18. 0 r g° " 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /D/Z�/ZOZS m a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF = N.) Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C <br /> CD <br /> r�i Jn <br /> Page 1 of 5 T- J <br /> Burnett County, WI Land Use Application-Rev 07/2025 <br />