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LAND USE PERMIT APPLICATION — Burnett County, WI ro <br /> � r <br /> a � <br /> Applicant Complete All Sections Below This Line ' N N <br /> Permit Types and FeestPlease,check appropriate boxes) a <br /> Dwelling/Principal Structure $3001 1 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure f$2 <br /> Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 � <br /> Driveways/&Campground Structures WI State Statute 59.692(ly)Structures $350 rr'Filling/Grading Boathouse $500Solar Panels(Stand alone or roof mounted) 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 /> v <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. <br /> z <br /> 0 <br /> Property Owner's Name: c� 2) <br /> 0 <br /> Property Owner's Mailing Address: O J GO • - �>� (,.�ct,t�,'Y W T <br /> _ City State Zi <br /> -"VS-7 <br /> Property Site Address: -"VS-7 -Gokw' /'�. Fi— t.J� �5f "-T— S-1yg'Q <br /> Contact's Telephone Number: ��� ��1� r �d C) a <br /> Contact's Email: lcl-xaa <br /> **If staff has a question ab t 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 -3 <br /> 5 <br /> `Legal Description of Property: r f CSm V1 P 59 <br /> Section#: 6 7 Town#: 4,9 N Range#:��W Town of:�-�anC�n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> � o � <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> `l o <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (dome/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> z <br /> Building Contractor: Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° N <br /> THIS PERMIT IS SUBJECT TO//ALL CCON/DITIONS LISTED BELOW: o o <br /> lvirf 6e US �r l�urMaH �lal��TaT/d�� X <br /> s�41- s ysA," I b e- s e-wi ced/ o;m aC re pe e q/ 0 5e <br /> le V &)may ,i Z/�/ZD � ' Fee Rec: P Oiv <br /> J// "✓� z Check#: <br /> r <br /> < <br /> z <br /> m <br /> n <br /> m <br /> v � <br /> D N <br /> Date of staff site visit: �7 2.D Z� Initials of s' -visit � r Gi B a Q <br /> CD a)F:- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: lS Ij �Z z C <br /> y = 0 <br /> UPON APPROVAL: APPLI ANT MUST POST C PY OF o 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> 3 <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application-Rev 07/2025 <br />