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.' ' LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line 7 u <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commerc 'Industrial Structure $200 <br /> O <br /> �( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Ace Structure $150 N n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration tr _,i,'' .,use $150 G� \ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0 <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. , ilk <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. or II <br /> o 1 <br /> Property Owner's Name: ; ,�\—y — "r' o <br /> o <br /> r5 PA <br /> a. <br /> Property Owner's Mailing Address: 1\ 67 1 ' S}tI Q_lYc\ m \) w. <br /> r—� �� ���City State Zip ' rn„ <br /> Property Site Address �'�� c Rio C" <br /> r � o c <br /> Contact's Telepho e Number: `0. 2,1 84 3 `' 8 36 \\ ° <br /> Contact's Email: 1 lr.it. 4 1 .lorb r 6 �iry, 1I • czyv\ , . fi- <br /> **If staff has a question about this plication,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following <br /> ^address: @BurnettCountyWI.gov Cro <br /> uo <br /> Legal Description of Property: L't' C J KA I Cad . c <br /> Section#:2-3 Town#: :taw- <br /> N Range#: ` -- W Town of 3Y\ 1©ill 5' �� <br /> *Attach additional page if needed for engthy description OR attach a copy of the deed OR attach tax system property page.* <br /> clq <br /> Tax ID#(1-5 digit number;found on tax statement):2+ L <br /> Proposed Use of Structure/Addition: <br /> Q cJ1u► A <br /> Anticipated Start Date: <br /> p �V _ Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N <br /> z <br /> Building Contractor: Sewer Installer: 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m IZ:6^ <br /> THIS PERMIT IS SUBJECT / tM <br /> TO ALL CONDITIONS LISTED BELOW: o Z <br /> (% Glgv'a e- BlotI / <br /> " v k u$e / -6r f'►u4n ho / o/lono <br /> F3 0 ,�, q t,kl Q CO Gs a f 9 yo 7z m <br /> Fee Rec: _�� <br /> ° Check#: CQ <br /> z <br /> r <br /> -C <br /> a <br /> m <br /> tr trr Lj <br /> v <br /> n ' fir_ <br /> Date of staff site visit: ��/q ZO Initials site visit staff: ri/1 oWO <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: // hJ ZOT-5 ��= <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF N -0 N <br /> o 0 o w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Pcri <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 07/2025 LL JJ <br />