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CD <br /> LAND USE PERMIT APPLICATION —Burnett County, WI _ b <br /> Applicant Complete All Sections Below This LineCD <br /> ° vi <br /> Permit Types and Fees�Pleose,check appropriate boxes) a.C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ p <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 /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $1S0 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 1 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. c <br /> z <br /> 0 <br /> Property Owner's Name: o { ," o <br /> 0 <br /> Property Owner's Mailing Address: 2 5- '-4 v''t?' S. 1 bl eqp,415ao w <br /> Ciq State Zip <br /> Property Site Address: N/10 Mmeyrti'S�c,l 12AM M, 1 J tKbiJr,, �-JZ .J Li g30 � <br /> O C <br /> Contact's Telephone Number: Ljl q —q6 7—6 G.�-3 <br /> d <br /> Contact's Email: SY CLUSe v- 07 P- qVyllcl i I >(OW <br /> **If staff has a question about this application, u will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> 5 <br /> Legal Description of Property: /VW AJW Lx \41 33 r d <br /> g . <br /> Section#: Town#:�—N Range#: 1 W Town of: Sw13'S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> ? qTax ID#(1-5 digit number;found on tax statement):��)� <br /> Proposed Use of Structure/Addition: &avyq <br /> Anticipated Start Date: u� 13*h 20 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: S`1e-%rW(1 l l�i�►�dl✓I4S Sewer Installer: '� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r .p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z -0 <br /> z <br /> Q tvccr 9eL sermcur <br /> Q 0T- ?b BE Hvp-AA-*l H-101 rofP161V. <br /> -� <br /> Fee Rec:� <br /> z° Check#:Z37 <br /> r <br /> •C <br /> n <br /> m <br /> Date of staff site visit: 9I 5125' Initials of site visit staff: r <br /> m <br /> a c_ <br /> APPROVED BY LAND SERVICES OFFICIAL: t 1 DATE: 9�7�Z°25' Cn m c° C n <br /> <_3 r va <br /> UPON APPROVAL: APPLI ANT UST POST COPY OF o o N [t1t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r C, <br /> CD <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 07/2025 <br />