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• LAND USE PERMIT APPLICATION -Burnett County, WI a Z b <br /> Applicant Complete All Sections Below This LineCD <br /> vNi <br /> a <br /> Permit Types and Fees fPlease,check appropriate boxes) G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ p <br /> r\ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)Structures $350 r <br /> Filling/Grading $150 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 X I Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> z <br /> Property Owner's Name: Sat Hauser o Z <br /> / 0 <br /> Property Owner's Mailing Address: d lfs A& 5YI19 g- <br /> Citf State Zip <br /> Property Site Address: 2ftri lUeo-ia Oam & <br /> � G <br /> Contact's Telephone Number: — <br /> Contact's Email: CWWKS CIOUV1.4701 <br /> **If staff has a question about this application,y1A will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following address: @BuettCountyWI.gov 7 <br /> rn °Q N <br /> 5 <br /> A',yVI as <br /> Legal Description of Property: A � /{/ EX <br /> g W 1�$S <br /> Section#: Town#:�_N Ran e#:� W Town of: 0 UK) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* —11;z�l Qn <br /> p. 7% c w <br /> Tax ID#(1-5 digit number;found on tax statement): �, / N x <br /> 0 <br /> Proposed Use of Structure/Addition: M <br /> Anticipated Start Date: (Home/cabin;Commercial Business;Bedroom;Deck;etc) W <br /> CC t <br /> Building Contractor: Sewer Installer: `n — _p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 <br /> r z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� <br /> c, FU►rn'4 2 X.�S i ors LA L- L40 -2L4 -4 l q S <br /> � FoVwj r,Ul t cord�+io�S l7� Lug-214 ►Ll <br /> , IO rA Fee Rec:� <br /> L � U2V �C� `_ rr o Check#:z <br /> m <br /> m <br /> 2 <br /> II--// <br /> Date of staff site visit:l�(�21�25 Initials of site visit staff: CL <br /> m <br /> (Tlzkz—r-�,- SATE: I s c,�,APPROVED BY LAND SERVICES OFFICIAL --• co co .7' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> 0 0 tit U a1J <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 � <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />