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Sv PAL bv}FPN P 'fovED <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a I <br /> N <br /> Applicant Complete All Sections Below This Line B.°� <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `(� p <br /> E <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 d <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 p <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °<, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C, ).1 <br /> Filling/Grading $150 Boathouse $500 0 P <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> d <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `2 <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c z—' .,, <br /> ° <br /> Property Owner's Name: 3650A1 40GU o <br /> a. N cN <br /> Mailing ( y3 U1, 7,6 2.d b <br /> PropertyOwner's Address: p� �9h��[J�Y s��'`�G n <br /> City, State�v Zip <br /> Property Site Address: (pi ir3 Lk 'U Uo Vq,s uey / i41- J < <br /> ° <br /> (p <br /> Contact's Telephone Number: 751 - q() ( <br /> — 8 tt _ n. <br /> Contact's Email: /JO gee Jl t/t yia/•/, Co/ i <br /> **If staff has a qu tion ab t t s application,you will be contacted via email. Make sure your email address is N oQ <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWI..gov 7 on _ <br /> A L, oe'for Z of Cetrtfi' thk <br /> GP e Otto,✓ourni6II/ArGa• ZS 9 Z7`,cocArrP °c oG <br /> Legal Description of Property:is/WC fiRACliOdiC Ski grit Of VI St.� 4Tr< OF d <br /> 5. <br /> Section#: (9 Town#: y/ N Range#: /r W Town of: suits S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* k,tkl: y <br /> Tax ID#(1-5 digit number;found on tax statement): 2 ( 5 G J i d <br /> Proposed Use of Structure/Addition: STog.4-6,r 0-3IV <br /> Anticipated Start Date: /Ci/ Z S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C <br /> Building Contractor: I-ideFS CQr(ST(z(Arlon Sewer Installer: 0c4 <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 /> w <br /> 0 Mee- aitit Stacks r <br /> mi <br /> C1114S <br /> �1.1.Dt IY`" ' �fI' . ( I O uSk ct -6- 6lJYYLUiVI 6,,bi Serra 0n `i m Fee Rec: <br /> Check#: )? - <br /> z <br /> m <br /> n <br /> m <br /> o l J <br /> cn <br /> Date of staff site visit: 1,0121/25 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL:G �/ DATE: t D'3U Z025 ro W <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 o (N� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT "ff Cal <br /> oK C' <br /> Page 1 of 5 CD <br /> Burnett County, WI Land Use Application—Rev 07/2025 JJ <br />