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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> . N <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> d X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 D <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C5-, O <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 . c t D <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 s. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' r- <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. o p <br /> o �- <br /> Property Owner's Name:Russell &Phyllis Slifer et al. Q w <br /> 1 <br /> Property Owner's Mailing Address: 2478 E Warm springs Ave, Boise, ID 83712 e. n <br /> City State Zip "' (/^, <br /> Property Site Address:4925 County rd C <br /> O w v <br /> Contact's Telephone Number:208-794-3901 n <br /> d , , <br /> Contact's Email: Rpslifer@msn.com a <br /> **If staff has a question 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 addresses: @BumettCounty.org and , °O <br /> @BurnettCountyWl.gov oa <br /> Legal Description of Property: Government Lot 4 \. <br /> n <br /> Section#: 16 Town#:40 N Range#: 15 W Town of:Jackson W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C Tax ID# (1-5 digit number;found on tax statement): S 3 a e <br /> l '-3 L.) <br /> Proposed Use of Structure/Addition: Replace Cabin <br /> Anticipated Start Date:May 2023 (Home/Cabin;Commercial Business; droom;Deck;etc.)) �/+ 1 <br /> (v <br /> Building Contractor: Dave Anderson Sewer Installer:T jl p ci4 O AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z ` v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a6�n �bf Ta �� Zy '�3%: <br /> O <br /> �G <br /> S 1 0 3e <br /> ® D u�-clo o r S Ll o t�er, � Le_ t/�+..vn o r�.or' �D y /I z Z C. ��.��p <br /> O /Vo 7� e-?C Uere_�C 3 4 edrbo y✓I S /p'e r S�/V— 2 3 /-�e g Fee Rec:3 0.- <br /> 71MI/ c�(o/�'l. cant /0 C.. wla l'Set t N e a/ 60 � d n 7 pag..1'l74"Or cri <br /> Check#: 179 <br /> eXp'2kv14e. / tzt`f/4cinf- q VC/rq.,YtG€ , 8 <br /> tri <br /> Date of staff site visit: cf/ 219 Z-3 Initials of 'te visit staff: IA/7-- <br /> xi ' J <br /> APPROVED BY LAND SERVICES OFFICIAL: 57'/U-� TE: -�/�0-1,Z 3 cn w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o z 5 <br /> D <br /> � CD <br /> CD = tl r <br /> SIGNED PERMIT APPLICATION/ IN PLAIN- c SIGHT P o e N <br /> 10 40M �Se? Z3.-, - o S7� SAow out vT Page 1 of 5 w <br /> Burnett County,WI Land Use Applic tion-Rey 2/2022 6 c, 7inn] <br />