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LAND USE PERMIT APPLICATION - Burnett County, WI � <br /> Applicant Complete All Sections Below This Line 0. c <br /> n 1 <br /> a `` <br /> Permit Types and Fees:(Please,check appropriate boxes) \ ---_L-) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 cO <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 0G1 • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r 0 <br /> Filling/Grading $150 Boathouse $500 0 �• <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 m <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 11. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro $ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -' 0 <br /> i ,• J w � <br /> Property Owner's Name: %-j p m t Q L '4- 1. Sea 149 m Q,11-0 VV <br /> 1 -n <br /> 7 <br /> 1,14 <br /> Property Owner's Mailing Address: 7S 3 -RQL) ;4 .0 h ilkc c • N.b v:zi . Spy <br /> City State i Zip = n <br /> Property Site Address: '7 7$ it,)11,D 1a AKc, r bf ) by.Z1/4..C-44(53 0 <br /> Contact's Telephone Number:r? 103" 3 S-0 °- (9 4 ! I • a <br /> Contact's Email: I i to es) k 0 rn @)z *AK)c , e <br /> Legal Description of Property: / '),.3 "Iov J 0 17 Pt kt. 1) 'DA t)b Oct./ `AZA 1 ) <br /> ac <br /> Section#: 3 3 Town#: &/ 1 N Range#: I Cp W Town of: S Qj ;..5 S <br /> P <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* E <br /> • <br /> Tax ID#(1-5 digit number;found on tax statement): a ),a 3 `7 CA <br /> Proposed Use of Structure/Addition: k S ,'Z-e-�.. /J QV S-9...., .--3 x <br /> Anticipated Start Date: t'J)y I 9 c:20 0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) . Cj <br /> Building Contractor: 0 Lk) r3 - R. Sewer Installer: (4 414 4 kJ," E <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t5" <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 16crwtho w WA */ k 01 AM a >parfS of sepfec taut. <br /> it 5crtcvt Naos` hef io IK v 4.. ,4•44 haW# " <br /> io Rlrsolufkv, IJO QS. i rgdii wiliiav► lift } saK�tk w� t4eut' <br /> a Pew t' Fee Rec: <br /> Check#:-/-'25kg <br /> Date of staff site visit: ( /23/26i0 Initials of site visit staff: <br /> // <br /> c;' <br /> APPROVED BY LAND SERVICES OFFICI• lop, _ / / __ ,A A DATE: 05/2026) x <br /> • <br /> M it <br /> UPON APPROVAL: APPLICA '- UST POST COPY OF al <br /> -, Q <br /> a3 = <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N cp <br /> NO <br /> r Do O <br /> Transcendent: Page 1 of 4 Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 < o �U <br /> r; w <br /> cm <br />