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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> Applicant Complete All Sections Below This Line CD P <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> Dwelling/Principalstructure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 vr- - <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $20 AAddition/Alteration to Bunkhouse $150 i;z ~ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)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. <br /> ro <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. <br /> z <br /> 0 <br /> Property Owner's Name: C� o 1 <br /> Property Owner's Mailing Address: <br /> n <br /> City State Zip <br /> Property Site Address:2\lnD �.��•'� �s\ z < <br /> o N <br /> Contact's Telephone Number: 1S\Z 'a50- <br /> d <br /> Contact's Email: � `' � �hioW i5 cmy CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b i <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °Q <br /> 5" <br /> Legal Description of Property: <br /> Section#: Town#: 46 N Range#: H W Town of: On <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> d <br /> Proposed Use of Structur Add' ion: <br /> Anticipated Start Date: \\ s (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> �/ z <br /> Building Contractor: YVSMQ- Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> v <br /> v + -b �k W to -CO Ir V W Vn Cl,� ► <br /> -� Fee Rec: <br /> z Check#: <br /> r <br /> z_ <br /> / sn <br /> Date of staff site visit: ��/ x -o Initials of site visit staff: b.4- a Q (�. <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL 1 DATE: 1' 13 Xz, 5.3CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />