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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI cr i <br /> b <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(P/ease,check appropriate boxes) -:- <br /> Dwelling/Principal <br /> Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accesso Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> (Dec 5 airs ati Retaining Wall/Sidewalk Bunkhouse $250 1 0 <br /> Driveways/&Campground Structures 12 WI State Statute 59.692(1v)Structures $350 o r� <br /> Filling/Grading $150 Boathouse $500 <br /> m I <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100 A <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> 'if*Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treate as accessory structures,such as:pergolas,landscaping,etc. ' <br /> o , <br /> Property Owner's Name: ;Q S k%Az k'S61— o W i, <br /> Property Owner's Mailing Address: ,A21'e Q°►,-\ 0 WT k.,qter3 I 'n N <br /> City State /YA'T. <br /> u, _Property Site Address: 3 0 <br /> / ^ <br /> Contact's Telephone Number: l/C' y 3,.-Oio .i- — a <br /> Contact's Email: - .. W i I S tyl/�f , I ` �f't'` d <br /> Q S r.C. <br /> **If staff has a questi7fn about this application,you wilQ_____, <br /> contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails fr the following ad ess: @BumettCountyWl.gov ' 00 <br /> ,, as y <br /> ( <br /> i0Legal Description of Property: 1 e ` rQ,�tecd� ♦ d -c <br /> Section#: .2,r Town#: 37 N Range#: 16 W Town of: (1741/ail =. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> sl' w 4 <br /> Proposed Use of Structure/Addif n _Ct .ci r L -i <br /> Anticipated Start Date: / // (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z Cs../2 <br /> Building Contractor: Sewer Installer: u, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: oz <br /> c l <br /> m eel- a se->�u u�S r 11..._� <br /> OC -1-(,(,1'l l k id 'N �c 3c,k,red t/6-14/1 Ct 1 DL4 (L ( n by Isis a C 0 ,�, � Fee Rec: I <br /> ` z Check#: (o 2gt), <br /> r <br /> J <br /> Date of staff site visit: I D/3O/ o2q Initials of site vi ' staff:-�r,._ -� Dg 4 n m CD <br /> � a e-7 <br /> APPROVED BY LAND SERVICES OFFICI DATE: 1 /2OZ' CD <br /> UPON APPROVAL: APPLICANT M ST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ f ' -- �I f <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />