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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> a ro <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and FeestP/ease,check appropriate boxes) <br /> d <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~ <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk IBunkhouse $250 ° <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)Structures $350 r, <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <br /> Solar Panels(Stand alone or roof mounted) 1$150 1 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 /> 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. or <br /> z <br /> 0 <br /> ITI <br /> Property Owner's Name: Kva vi h o <br /> 3 ,log ss� <br /> Property Owner's Mailing Address: <br /> 1 City State Zip <br /> / ' <br /> Property Site Address: IP0 S L 1-,1S)I I11 , <br /> Contact's Telephone Number: 612 . �SO ,�d/j L/ ° <br /> Contact's Email: f d f Q yl pPct l'-' Va 1/00• G 4 <br /> **If staff has a questio�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 <br /> � o' <br /> Legal Description of Property: L o4— r2 L S� s-'Q � VOL ;�h d? IC) d <br /> Section#: b�Town#:__�__N Range#:15 W Town of- <br /> 5. 0 <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): 3Q 7 LI Z <br /> Proposed Use of Structure/ dd'tion: <br /> Anticipated Start Date: C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) , n <br /> x <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z ' <br /> THIS PERMIT IS SUBJECT TO ALL C//ONDITI/ONS LISTED BELOW: Z <br /> IUI)f <br /> m <br /> (A <br /> Fee Rec: /50F <br /> °z Check#: r2QYA <br /> r <br /> -C <br /> a <br /> m <br /> n <br /> m <br /> d v <br /> Date of staff site visit: $�Zd 2r Initia of sit visit staff: T G/a- a W - ��- <br /> m a) <br /> APPROVED BY LAND SERVICES OFFICIAL: TE: ! ZOz� =` <br /> < 3 �v <br /> 5E�r <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF ro <br /> 00 <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> co 2-1 <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 07/2025 <br />