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. LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> i <br /> Applicant Complete All Sections Below This Line o' cn <br /> Permit Types and Feeselease,check appropriate boxes) °' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .,5- 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 m <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125_ WI State Statute 59.692(1v)Structures $350 o Q. <br /> Filling/Grading _$150 Boathouse $500 <br /> cn <br /> raD <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 _ <br /> L �- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. I. (r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r z (' <br /> �E� 5�� A o -I <br /> PropertyOwners Name: <br /> A o <br /> Property Owner's Mailing Address: /0_3 1 �CLIP.14 6 4�6 r f: f 1g I 6' <br /> 6 .31,5 City State Zip vn, N <br /> Property Site Address: 0 ��T t L o <br /> 4,37 1'fb `7 �a Z o. <br /> Contact's Telephone Number: D <br /> �-�" r <br /> /� d <br /> Contact's Email: c'Pbt A fv04 �**If staff has a questi ut this applic on,you will be contacted via email. Make sure your email address is N o <br /> legible and your email provider will accept e ails from the following address: @BurnettCountyWI.gov _ o <br /> Legal Descriptio of Property: � L / d <br /> Section#: 1 Town#:j___/._N ,4�Range#: / 6 W Town of: f O A to <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> 47 . <br /> Tax ID#(1-5 digit number;found on tax statement): 1 1e,... <br /> P' ... g d <br /> Proposed Use of Structure/Ad tion a g <br /> Anticipated Start Date: i l7 <br /> 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) a <br /> z <br /> Building Contractor: Sewer Installer: at 4. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r°n `1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o �, <br /> ©►t a -r Alt_ seif3Ylck.s m <br /> ® A tl. ID tE USED Falk I-)Mj,FKJ tieiCPTArn tYu n <br /> rn <br /> d i?ei%.3y 'lb BE R ei4LDUCII Ti..o Talit4titreD i3Y 121//4'-'45- <br /> mFee Rec: �0b <br /> °z Check#: /aq„14 <br /> r <br /> -C <br /> z <br /> m <br /> m )mil I I <br /> m r <br /> Date of staff site visit: l ol's Initials of site visit staff: p <br /> APPROVED BY LAND SERVICES OFFICIAL: / \ 1 - DATE: /6//6/ZoZ5 <br /> " k' !Q.-67 UPON APPROVAL: APPLIC T ST POST COPY OF <br /> M c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ro <br /> Page l of 5 JJ <br /> Burnett County, WI Land Use Application-Rev 07/2025 <br />