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LAND USE PERMIT APPLICATION —Burnett County, WI C r <br /> a <br /> <' b <br /> Applicant Complete All Sections Below This Line ' a <br /> Permit Types and FeestP/ease,check appropriate boxes), <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure <br /> \ � N <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 \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk iBunkhouse $250 1 ° (�y <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)Structures $350 S 1 <br /> Filling/Grading $150 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> NOTE:After the fact ermits ermit 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. CD <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: nay il <br /> Property Owner's Mailing Address: © L. tT�5 e / Sol n Ch�" ity State Zip ° W <br /> Property Site Address: 206.2 �i j5Dt1'1,. NCL 1&J115-An1=- (A) S eT93 <br /> c <br /> Contact's Telephone Number: f - ( 70 bQ y 0 <br /> ` d <br /> Contact's Email:. Ra,w It 1k A) -r <br /> 464w <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov <br /> Legal Description of Property:Y��OT I CCAA V I e Z 10 OL( �CGOV L07S/ ?,4,5)KAf-*Zy-/ d N <br /> Section#::—Town#:_yQ N Range#:__Z —W Town o£ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v� <br /> o � <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> � I o d <br /> Proposed Use of Structure/Addition: ( '1010.� C"X f S�J-ry? C�c.ks <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) N <br /> z � <br /> Building Contractor: Sewer Installer: y O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o �;0 <br /> M <br /> m <br /> y <br /> a <br /> Fee Rec: «111L <br /> °z Check#: <br /> r <br /> Date of staff site visit:2 3 Zc Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: <br /> � � Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> CD <br /> Page 1 of 5 � <br /> Burnett County,WI Land Use Application—Rev 04/2024 �-� <br />