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LAND USE PERMIT APPLICATION—Burnett County, WI ro r <br /> a g <br /> < b <br /> Applicant Complete All Sections Below This Line I: c W <br /> Permit Types and Fees4'Please,check appropriate boxes) a' <br /> to <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 to <br /> \ <br /> ( <br /> AllCommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '`i <br /> ccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> \ Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1� <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ \` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' ►v <br /> Filling/Grading $150 Boathouse $500 CA <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100 c �\ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. v � <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 'D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ..' <br /> Property Owner's Name: I eti /€ Lj 'to! <br /> 11,' 6/Lb/Z...� <br /> 1 itiliN <br /> Property Owner's Mailing Address: ij ti In 8 <br /> 8 n C, <br /> �� I , �[ Piciikoti ity Li Stag` Zip 3 I* <br /> Property Site Address: -."��]- ik7 < <br /> O <br /> Contact's Telephone Number: 02 — ? 13 2__ , a <br /> Contact's Email: d1Zr I� co <br /> �f1 ,� 1 /Act `- o / IGi 1. 1.t rii <br /> **If staff has a question about this application,you will be ddntacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = 00 <br /> @BurnettCountyWl.gov 1 cm <br /> Legal Description of Property�6�S l i a 3 1 /(,XJII,� c 'L to iS�addotO niz7. <br /> i p <br /> Section#: Town#: N Range#: W Town of: clA.)(SS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N a x <br /> Tax ID#(1-5 digit number;found on tax statement): A 1 6� :/ <br /> Proposed Use of Structure/Addition:� ''OI'a F. <br /> NI <br /> Anticipated Start Date: -I- (-r (� .kl&Home/Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> Amerttavi 51 L wild'n h II wl d s qvrthir <br /> Building Contractor: i Sewer Installer: 0 eit (�0 z <br /> AREA BELOW THIS LINE FOR LAND SERV CES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `^' <br /> 11 <br /> - / a,J rt-/-b <br /> -No-- -For hu mxii I ,i-/ .0-7 <br /> Y Fee Rec:�"' 4 1,5o <br /> al Check#: 74194r/cf, <br /> L� <br /> = iffd <br /> fly/2D23 fff'C�' <br /> a <br /> Date of staff site visit: Initials of site v' it sta co 03 <br /> I <br /> cAPPROVED BY LAND SERVICES OFFICIA : DATE: v 20 -rt <br /> Page l of 7 Rs <br /> ,� r <br /> Burnett County,WI Land Use Application—Rev 5/2023 `. <br />