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C � l <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line e <br /> Permit Types and FeesfPlease,check appropriate b `y <br /> C7 <br /> Dwelling/Principal Structure 300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure 3 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 r <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 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 /> El <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: <br /> 0 <br /> E. <br /> 0 <br /> a <br /> Property Owner's Mailing Address: <br /> City tate Zip V) <br /> Property Site Address: S�(� < <br /> o <br /> 15- 1C0-2031 CC�5s� �J'SC'rv \ <br /> Contact's Telephone Number: <br /> Contact's Email: y C-W(-Ck-\ �1�1�1S•Lom <br /> **If staff has a question about this app 'cation,you will be contacted via email. Mak sure your email address is N <br /> legible and your email provider will accept mails from the following address:@BurnettCountyWI.gov o0 <br /> 5' <br /> y:T c y 2 (�� NWk[W NE Legal Description of Property: 1 ��� \ ���� � <br /> Section#: �0 Town#: T� N Range#:_UD—W Town of: �W lVl <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Jp <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: C) W y <br /> Anticipated C,AtockStart Date: (Home/Cabin;Commercial Business;Bedroom;Deck,etc.) <br /> Building Contractor: INNgS Sewer Installer: > <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> /Usf 1f D <br /> >n Fee Rec:��11� <br /> °z Check#:�( <br /> ►' b1A 1'/ally a[A01 le-qK -�V, <br /> ► m <br /> s� Aa//v�ss �► Usf- �e ©�f4f�� di000z0 4s- <br /> Date of staff site visit: $�►Z/ZO Z_5— Initials of site vrsyit staff: T B, a <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: <br /> CD Cr <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ?. <br /> a3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 07/2025 = <br />