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LAND USE PERMIT APPLICATION-Burnett County, WI g ro <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Please,check appropriate boxes) °' t 1-i <br /> v VIDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ 0 <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 /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i klj C <br /> Filling/Grading $150 Boathouse $500 <br /> PA <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 .... <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ 'C7/ <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. g' `. g. <br /> z <br /> c <br /> Property Owner's Name: ,T9jylf' AfSG Ers <br /> Property Owner's Mailing Address: 2708 TM/ / 4ke ,pj�'.4U6/(�ODc�du'y /�9ys3- E.a6 n <br /> City ---/ State Zip 3 <br /> Property Site Address: 4,27y87 //0,6o,9y PQLA/j '61L/ o• ,t2s, ,e( o N <br /> Contact's Telephone Number: 65CD <br /> / 3/,— 's6a a <br /> • d <br /> Contact's Email: Jin/ 0 G�1 GD/yG& ref = <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,9 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and c °0 <br /> @BurnettCountyWI.gov 34 3dcr0 /V A/41.2 d <br /> Legal Description of Property: S j'; 4,5'3/ 77p,/ ie./d5W 6. <br /> Section#: 3/ Town#: /p N Range#: /& W Town of: l�s f/22y/a.-/4 .(/ `4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* V <br /> Tax ID#(1-5 digit number;found on tax statement): agm) d <br /> / y A. <br /> �� / ! <br /> Proposed Use of Structure/Addition: ✓•��� a... ', ,?•f,Ap f <br /> Anticipated Start Date: St/p f p'l V 02.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> II ,, <br /> Building Contractor: �G¢,�- ��ZCG Sewer Installer: �'((j k,kI.5 ; <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/C NDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ' <br /> creek- aft Se-6c <br /> N� �r h4/444 h� ,t 1 a <br /> � A LyrI �,J ((t Dv2r S ( �acQ�d 'f� b� f�Ea� ,74 <br /> x Fee Rec:Si ORt o Check#: S 435 <br /> Date of staff site visit: V 'o l a3 itial of s' sit staff: n�% x rn ��� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 <br /> Vl n ...--"ISIGNED PERMIT APPLICATION IN PLAIN SIGHT . w= Q <br /> Page 1 of 5 m 3 `A' <br /> Burnett County,WI Land Use Application—Rev 5/2023 0 a <br /> (L J <br />