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LAND USE PERMIT APPLICATION —Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line o cn <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> d E <br /> y . Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 e <br /> l0 <br /> Accessory Structure(Garage,Shed,etc.) $150_ Addition/Alteration to Accessory Structure $150 e g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 '" <br /> o <br /> Filling/Grading $150 Boathouse $500 0 1‘� <br /> Solar Panels(Stand alone or roof mounted)_$150 Permit Extension(1 Year Extension-Allowed Once) $100 N I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. kA) <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. or :=... 1! <br /> .. z <br /> o <br /> Property Owner's Name: f Z' \ <br /> P Y AA b j2. I /V i\i �\ 4Foloi 0 6� v�bN " ,Property Owner's Mailing Address:O(j`3 18" © b/JeCO�`A� N1.itl c E. N <br /> City lam-fl2 L State Zip <br /> - `r�� <br /> Property Site Address:4 0,4 'T7L/ss 1 :' . / SPQ5A/c{-) j k j so I o c <br /> Contact's Telephone Number:—AA 3 /kat -32�7E) _ a <br /> \ \1 d <br /> Contact's Email:Q,,o(' \ 4\ jo al 1 • M <br /> co <br /> **If staff has a question about this applicration you will be contacted via email. Make sure your email address is S, a <br /> legible and your email provider will accept emails from the following address: @BumettCountyWl.gov 5 to <br /> Legal Description of Property: Lai- Lp C.. ose V ZS P 2_4 \ d <br /> Section#: 1 Town#:A ) N Range#: 1Lk W Town of: ' . Tv- VI <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> 2�- o <br /> TJ Tax ID#(1-5 digit number;found on tax statement): 1 va <br /> Proposed Use of Structure/Addition: pN rT�,ci 4)A) <br /> Anticipated Start Date:1 f:?/2{)f Z�5 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) KA <br /> S <br /> Building Contractor: 8 -r" Sewer Installer: p R.1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o Z <br /> $hG T ALL SET3*'4CGt5 a ` <br /> ® `b.c c.u.J Cr AjeyT TO vesep / 1&o?c:,& ft-R SAA -25- ZZ I . m <br /> Q C'O,U'CLkCA- OP c_ miSPEcrpEi Fog- r4/t1y /tZCF$t4f y Werkt r5. <br /> /� Fee Rec:J�(d - <br /> q ,vOt 'to EKGEE(> qo Poor HelutiT: O Check#:7Dab r- <br /> r <br /> -C <br /> a <br /> Date of staff site visit: Ib,Zo Initials of site visit staff: 11 <br /> APPROVED BY LAND SERVICES OFFICIAL: \ I „IA DATE:/o/27/Za2s < . -� <br /> UPON APPROVAL: APPLI T ST POST COPY OF 01 <br /> roc <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - ra, <br /> Pagelof5 L ) <br /> Burnett County, WI Land Use Application—Rev 07/2025 .LL.. <br />