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LAND USE PERMIT APPLICATION - Burnett County, WI c ro <br /> Applicant Complete All Sections Below This Line o c ccn � <br /> Permit Types and Fees(Please,check appropriate boxes) V d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r- <br /> v <br /> Corn ' <br /> mercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 S' u O <br /> � F <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W P. <br /> CI <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 d ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i <br /> Filling/Grading $150 Boathouse $500 < g <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> I4► <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. 2 r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 0 z <br /> r� /i o <br /> Property Owner's Name: ,}f� / �l 0 7 /l a A C e o _ N <br /> a. <br /> Property Owner's Mailing Address: 6 a ��an Abe A4,1 Zs- de '( 4i /'i4/ 5-5V I ''1.. <br /> 1 <br /> 9,.?oZ. City Zip np --/ - ,/l/L/f4't T eet LC2te'y�'y3 1. <br /> Property Site Address: <br /> r n / o c <br /> Contact's Telephone Number: &5/ "(2 s 1` Li L/v/ a <br /> j /1 , o <br /> Contact's Email: /V D/�') l e it 7 [ 6 /1 k/L` ` L O�'1 --Qi : <br /> **If staff has a question about Os application,you will be contacted via email. Make sure your email address is —1 <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov . cpa U <br /> Legal Description of Property:LtiT i CS rvl 614,14 VD L 2 9 P I la 6 o c b <br /> N <br /> Section#: 22 Town#: go N Range#: 1 6 W Town of:T ack . <br /> c✓1 U rJ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 3 6 1 ( N f <br /> ,...., . 6 <br /> Proposed Use of Structure/Addition: S f e 1 a l e c 1 v'' <br /> Anticipated Start Date: D e :, S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> -� ' <br /> w <br /> Building Contractor:N.I PS S�.e is At (ter D� Sewer Installer: cn cn O� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o Z <br /> NCA <br /> fe+ CO Att/kS m X <br /> m <br /> ID No+ 4 � u0 4( hum htbi+a-�'m ► SV(€ t ly rr, <br /> v, <br /> p CI Fee Rec: sl i 5O P° <br /> P D U!: Q C(1/n 11f CaS a Lod ace (k1'(Yti+- bq I2 J I I2,0 ci Check#: C'►A51--1 <br /> < <br /> x <br /> m <br /> M J <br /> Date of staff site visit: (OIZgiZ0ZS Initials of si visit staff:`l.El cAr <br /> XL O M <br /> APPROVED BY LAND SERVICES OFFICIAL �s'<��� DATE: I0/3U/ZOZS CD ly,co <br /> W n CD <br /> � c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N 0 U l <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT @`` cal <br /> Page 1 of 5 I <br /> Burnett County, WI Land Use Application—Rev 07/2025 `�---J9) <br />