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AND USE PERMIT APPLICATION - Burnett County, WI a r <br /> L <br /> ,7. N <br /> Applicant Complete All Sections Below This Line o (.4 <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200fp <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 /> n <br /> X/ Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o kki <br /> ,J� Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> i <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. k <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. co v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g I i <br /> z $ <br /> Property Owner's Name: , l� i3L Q R S V <br /> F. <br /> o <br /> Property Owner's Mailing Address: 8 / EA E IA/a) £/ i V E w1'63C.7/ n (r' <br /> A LL.�� r p , p f QQ City State Zip `" <br /> Proper it��ddress:sYgfliti E.V' ft>en.T (//e WI- 7C 5;r tL% cq '7 N <br /> Contacts Telephone Number: Gs <br /> .� <br /> � a <br /> Contact's Email: f e i r l t Gam`6� s .. �///Q vt�'On r vi CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ? <br /> @BumettCountyWl.gov I ` ,� i� <br /> Legal Description of Property:L.D� I C./,/ V pZ f� PcT I (5&t2 ) 4-450.93g <br /> Section#: 3 1 Town#: 3 I N Range#: 16 W Town of: i'h1 t ''.°' 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> 3ag3q a d <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> lk <br /> Proposed Use of Structure/Addition: C( k 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ) "-C) <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -ee-1- 4 bl 5 'Jci r <br /> 51Q6( litic)-i--Tvi k•it,,,,,,,Pt iit4.6,+,,-- )7) <br /> x Fee Rec: <br /> o Check#: 4 <br /> Et <br /> z <br /> , l <br /> o <br /> Date of staff site visit: 513cn t- <br /> 1f Initial of site visit staff: lib: < Q NI <br /> 9 m co <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:5/3/a3 N < _ �? <br /> -3 c C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rn CD [fill <br /> , 3 w <br /> Page l of 5 < ? I 1 <br /> Burnett County,WI Land Use Application—Rev 3/2023 a J� <br /> -a <br /> a <br /> t <br />