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LAND USE PER Ir PP IC AA VPB C�TIOurnett ounty, W1 a <br /> Applicant Complete All Sections Below This LineCD <br /> v <br /> Permit Types and Fees:(Please,check appropriate boxes) a ,{`rw/V]w/[\1 <br /> P y s <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C� Q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 (�f <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. 2 <br /> b <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. o <br /> z <br /> o <br /> Property Owner's Name: L(.4, TVVV11 KW K <br /> g 1ta� . 0[ !1l laow►1 MAI R Z <br /> PropertyOwner s Mai Address: , <br /> -rAvc M 71014 City State Zip <br /> Property Site Address: 41 >. o c <br /> Contact's Telephone Number: (p a <br /> Contact's Email: \Q�►yl�a-ZY' 'V1�` °C Gf� eci3�� <br /> **If staff has a question about this application,you 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: @BurnettCounty)VI.gov . <br /> Legal Description of Property:�eS NW /4'c6 4O V(24 I1P/I� 14* <br /> Section#: Town#: L10_N Range#: 1!5' _W Town of: Jam <br /> *Attach additional page if needed for lengthy description OR attach acopy of the deed OR attach tax system property page.* IV <br /> Tax ID#(1-5 digit number;found on tax statement): VT Q <br /> d <br /> Proposed Use of Structure/Addition: VO'L X $ 01. 16 0 4 Sh ' `kC4-M 05e <br /> Anticipated Start Date: l�P20 LYPWV ? (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: / Sewer Installer: VJA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> © ✓►MEET- ALL SOT-C ACI-.T <br /> OZ A)-)T 'Ca 8C 0ED FoR HvvuAry +4s16 1rATt oN M <br /> 03 APPI_y 1=60. 0100RfSS 2*1 lo/15-12a25 <br /> MFee Rec: 150— <br /> Check#: <br /> Date of staff site visit: 9/1o'7_57 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:TL20Z5- o N <br /> UPON APPROVAL: APPLIC &T MUST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 07/2025 <br />