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LAND USE PERMIT APPLICATION —Burnett County, WI `° b <br /> y N <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and Fees(Please,check appropriate boxes) C7 (r <br /> Dwelling/Principal Structure $300 y Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Q p <br /> E <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 5). <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t— <br /> o 11 <br /> Filling/Grading $150 Boathouse $500 v <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. 'Al-. <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. z <br /> r <br /> Property Owner's Name: T Ago V -4- Ki",t2 IIt WMit aii. I F <br /> $ -A r <br /> Property Owner's Mailing Address: / 6003 04 iA16 r2- remy NG O1-47/— W/ 5 0.1 -....j <br /> City State Zip cn NJ <br /> Property Site Address: 2-7 q`f5 ,SK...t J LO C/E./�D �(,,�1t35.f t /�— r lye/ 1 S-t/8 f 3 <br /> P <br /> Contact's Telephone Number: I 15 777 65g: ( o' <br /> d 6 <br /> Contact's Email: My /l1-1-- 'p AOL.. Le <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N Q I, <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov °. 00 <br /> PI �Z 1 Legal Description of Property: G b <br /> Section#: 2.6 Town#: 40 N Range#: /5 W Town of: (1,71e,iciel,.ti/ 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �, <br /> N o <br /> Tax ID#(1-5 digit number;found on tax statement): Jt- (o 33 — <br /> Proposed Use of Structure/Addition: fitfi.V ,i �� <br /> Anticipated Start Date: 0�j- Z.'i I- Z e R:.S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:a Di t ex 40 y✓/LE (s.�c i' Sewer Installer: A,/4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> Qboe,/lltoy Nor A exe.e-1 z be irootfis Der sou17G/ ,fr ferima ` /907Z < , <br /> 00 folio LDH4 /si D e# U S q V'e_q IM/7749T701'1 ,,,,.E'il 1 V -C- t`Z-c a r� <br /> Q a(�G//tt 4931911./ / Fee Rec: c9()[ <br /> __//__ �` ° Check#:�5�Z <br /> in Co LAAac /� .i N5,ec5lov' 70 See_ is �f e y y $€ Ca r6,,,,,t/T <br /> n <br /> to <br /> rri <br /> G t---0 <br /> Date of staff site visit: !t("/ ZtZ5 Initials of site visit staff: /i G,,a, a, 1� <br /> ` �� D ZOz 'n �u] <br /> S � — DATE: / / $ m c • 1 �� <br /> APPROVED BY LAND SERVICES OFFICIAL: .( Z.j u� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 0 rC�u]i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 cri <br /> 6 <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 07/2025 T�D <br />