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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> co N <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes) 5, V <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a. c>i <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..) <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °i Sr <br /> e • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> o ` : <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 *\ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 1 ('� <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. I 1 �1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> _,�)I' <br /> Property Owner's Name: / dig 'IL) f e7/,Z/Q ne?H ol---0 /Z9 Del ., .r, N% <br /> '1' _ y.. • kr, <br /> Property Owner's Mailing Address: 576 iaArher.v776At (1->&17/›.74,720115/' -2. <br /> �° / /�� State Z' n � <br /> Property Site Address:`'" 76 7Io �/�!� �� �'� "� w� f Z C y <br /> e-.21— /7— �972 <br /> Contact's Telephone Number a <br /> 10. �� 40 C� T/2?�-,L , tj')i% c-0 d <br /> w <br /> Contact's Email: `° <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email1dress is , <br /> legible and your email provider will accept emails from the following address:@BumettCoountyWI.gov )Z017 S. 0 <br /> Legal Description of Property:'' 5 Cf// ' 3b24 vice 1D/'! (60"r J0. <br /> Section#: .'= '7 Town#: 'ft) N Range#: 45-- W Town of: -.7g2 aecro <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): 7 7 D , J ,. \ d <br /> Proposed Use of Structure/A iti n: MA')e/i)w L/iv6:? `� <br /> icipatedS tta Date: / oZ®A. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) , J <br /> / 0-44 IO///',S Sewer Installer: El <br /> o <br /> Building Contractor:�� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: > Z <br /> D tv + Mte+ CtA Se,+bct,.c.1s. Cr;-- Co Se.-Nou.t:(5, "I 5 -F-�- -kc 0 MA3,1/I �t�l <br /> jam" -1-0 we,--Kai d Ul <br /> CD INAt�a to nb-� -b - e-e-ed 3 6611°111S Pei M iv"zS Z I I Fee Rec:3Od <br /> 9 Check#:325 <br /> © ;ln� no+ txieed a hel elf 4 `10 - F <br /> 6CO udC Ins1 c,-�� ` Or bsct r m ry pe t fS ��oJ <br /> Date of staff site visit: 1212/25 I Z Sl25 Initials of site visit staffs l u i v <br /> APPROVED BY LAND SERVICES OFFICIALG biirldth`ti DATE: 1215 Zp25 < E c-) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF - ' o <br /> �'< ro <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 — �L <br /> Burnett County, WI Land Use Application—Rev 07/2025 <br />