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Ln <br /> LAND USE PERMIT APPLICATION — Burnett County a R <br /> b <br /> N N N <br /> Applicant Complete All Sections Below This Line a �!' <br /> Permit Types and FeesjPlease,check appropriate boxes)' C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 ^� <br /> Commercial/industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> t✓ Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 0 1 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 <br /> w <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,andfees. 1D ' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> 0 <br /> Property Owner's Name: o <br /> Property Owner's Mailing Address: V t m <br /> City State Zip <br /> Property Site Address: �Z�lo o` L�a <br /> CD <br /> Contact's Telephone Number: 5&3 3 R D -3 3 3 V <br /> L N d <br /> Contact's Email: / V <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N 't <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov '- <br /> � N <br /> � o <br /> Legal Description of Property: N <br /> h <br /> Section#:_6,7- Town#:_39 N Range#: 1!y W Town of: Lyec�( <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): <br /> tt 3oZ I sl N d <br /> Proposed Use of Structure/Addition: ,, �.e <br /> t�.c4 o W h <br /> P w7"Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc. Lt5 <br /> W. <br /> QD <br /> Building Contractor: Sewer Installer: tj .A PV-- Ti N <br /> AREA BELOW THIS LINE FOR LAND'SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z z <br /> rnEEr qu S�-tegckS � � <br /> Q n/o T- TD BE L(SE D ;rn yv.K,gN HAQiT/1?7 o N <br /> C <br /> a <br /> Fee Rec: <br /> °z Check#: <br /> r <br /> < <br /> r <br /> m <br /> < Q <br /> ti <br /> Date of staff site visit: q/21 2o75 Initials of site visit staff:7R ' <br /> APPROVED BY LAND SERVICES OFFICIAL: e DATE: 42 C5'CD <br /> (D <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/20 24 <br />