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LAND USE PERMIT APPLICATION — Burnett County, WI a ica b <br /> Applicant Complete All Sections Below This Line 0 um <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> a ' <br /> — - C7 <br /> kl <br /> Dwelling/Principal Structure ei,$300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r- O <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 1 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < _4 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' V` `' <br /> Filling/Grading $150 Boathouse $500 v7 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ W <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. c Z P <br /> o <br /> Property Owner's Name: -Ile.c r i . -3 t 4.,J c�..v\A -,nzi vex o <br /> 0 <br /> 0. <br /> Property Owner's Mailing Address: )►/ 0 7-Ca cf I r' t x C9 f h ( <br /> 5' , L W �- 5 `1�'y 0 1:City State Zip ° <br /> Property Site Address: I `i U LC Cr, e t Ti 24) G t C (S 1-u L S 484 O c c <br /> Z ti <br /> Contact's Telephone Number: -1 l S-y 3 I - 01 39 • a <br /> • <br /> d 16 <br /> Contact's Email: 1O % vta f_t'y O 0 Ct O c--O-.IN, co <br /> **If staff has a question about this application,' ,�you will be contacted via email. Make sure your email address is No <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov C/O s <br /> Legal Description of Property: S l5 A C 0 S C YL 5 Ir 5W. d N <br /> a 4 <br /> Section#: '3 LI Town#: 3 S N Range#: l 9 W Town of: WB 4tJ4'1 occS LiciA•t_C a tr <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): 2.g j I 1 W i <br /> tv <br /> Proposed Use of Structure/Addition: 530Py_, _ <br /> 0.0 <br /> Anticipated Start Date: AS/�"Q (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) :+ <br /> 3-3 <br /> s CN _1 <br /> Building Contractor: 5 e I c' Sewer Installer: 0 �Q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m g:, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d `^ <br /> Meek ai), -I'ba.c. S <br /> ENO+ l02 uSe d -Po, LA" `"` habi-1-uh r '� <br /> 3(�'rern p. car or+ 4° he. re.+to w1°o corn Ole-4: v5 2L '-1 X`-t0 ock Fee Rec:, <br /> bLI lI1ln/Z02Ae • i-c Y1.o4 re,moh✓t -4'In.un U pc )S Vlkeg-e-cj . z Check#:t;, <br /> -< <br /> I..Q°I Sht61 ittedi a Land z? /yvl14- by 12116/2025 ? ,_..e...®._.� <br /> Date of staff site visit: j`I LiV�ZS Initials of 'te visit staff: YS <br /> /APPROVED BY LAND SERVICES OFFICIAL% DATE: 11! 6P/7 5n -: o ifilii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ° C <br /> r, <br /> r` ) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' <br /> Page 1 of 5 t CC-0 <br /> Burnett County, WI Land Use Application -Rev 07/2025 <br />