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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> m lV <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees(Please,check appropriate boxes) C <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk <br /> Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. V.( <br /> 0 <br /> Filling/Grading $150 Boathouse $500 w k <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R. <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,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> Property Owner's Name: AA C. 1tUpc d 8 0 <br /> I ' c. L. <br /> Property Owner's Mailing Address: 4 �v�J LA-Kit-- ` a.tMcribt Z (a.001 u n r <br /> 3 �Q � �( �, City ,,State Zip � <br /> Property Site Address: ` t �"/ T 1�'-'`'c'G\ nIJd 6. W I ��s50 c <br /> Contact's Telephone Number: b'I 1 "L4 P..1 - (I/7 31 a. <br /> Contact's Email: '''Q.R�. ?L v JZd `r S Th Za-C , Co M <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: @BurnettCountyWI.gov �. CM <br /> '1 00 <br /> Legal Description of Property: 5 e e lot V1k Ike-0 - 241-c4 a C SM\ 9`1 (cms* p. <br /> C <br /> Section#: a_ Town#: 40 N Range#: �� W Town of: I''�✓tiSo,J c' <br /> *Attach additional page if needed for lengthy description OR attach,,a11copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): (� ,,��-j� , d <br /> Proposed Use of Structure/Ad ition �,— V'rt 1,b1 r po room ems"i5 i-- .3 <br /> Anticipated Start Date: 101 (6J 1�1'' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: le (.L'n15'C1tC1C.A-101 Sewer Installer: N C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z <br /> Q IMEET ALL 5E 9010 5pv <br /> © D.,)EcutiYr n,or To EXCEEb 3 get) (eQ7Rows Nk SAN- 0 - y <br /> -��n Fee Rec: 10(43 <br /> ° Check#: /U&9 <br /> r <br /> ri <br /> m r______J L J <br /> cn <br /> Date of staff site visit:l0/7 Initials of site visit staff: Inn <br /> b Q. IJ I <br /> APPROVED BY LAND SERVICES OFFICIAL: ‘<- %,..i.k_ DATE:IOI14IZo2S co <br /> <.3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 M <br /> 00 <br /> . IV cc <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I <br /> Page 1 of 5 �11 <br /> Burnett County, WI Land Use Application-Rev 07/2025 �L �J <br />