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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> ro <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees(Please,check appropriate boxes) z v w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 o <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 --CD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 — <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 A Permit Extension(1 Year Extension-Allowed Once) $100 P <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> 9 <br /> Property Owner's Name: TALI I ( M/et i 8 <br /> Property Owner's Mailing Address: 621q, Iticbtek.Q 1j I` 6444 flu 5S/23 m <br /> City State Zip up ` <br /> Property Site Address: `IQ)3`-} -k-vcA(A..k -Re\ Wrb5t v W 1 5'4B 0 <br /> • c <br /> Contact's Telephone Number: (D S l -9oet 'g€8>1 1/40 A. <br /> d <br /> w <br /> Contact's Email: PJG,_i„t .v., (iiCo casf". neV <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .ti k".° <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and at) <br /> @BurnettCountyWl.gov o <br /> 0 <br /> Legal Description of Property: 1?v S QS Q 4 dk. C.c,F `f ff. <br /> Section#: CAI Town#: 3a N Range#: t 'S W Town of: G.a Pra)i .@ i-Fe__ up <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* --.00 <br /> Tax ID#(1-5 digit number;found on tax statement): I ( 2.3(=, v <br /> Proposed Use of Structure/Addition: 9 avq, c_/S -S ---)4-.c - -o v., J4zu /S'vt old L4 e' vip I_ N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck,,etc.) W <br /> III. O <br /> Building Contractor: 'T k,e (—I,_ 4,ri,,,4c./ Sewer Installer: 1.Uctcl ee- R-E.11c,/✓r) <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> z Fee Rec�(�. <br /> o cii <br /> Check#:1�j'727 <br /> y`556 /07? <br /> z <br /> v <br /> -7— m <br /> Date of staff site visit: (i//Z �Z3 Initials of site isit staff. ( ,.S l <br /> 11^_ ? v r <br /> APPROVED BY LAND SERVICES OFFICIAL � DATE: ll' 1 �I��3 v, 010 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF fl z 0 <br /> r o m RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m o gCo c N 11 <br /> Page l of 5 < w <br /> Burnett County,WI Land Use Application—Rev 5/2023 d c <br /> a � L J K <br />