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LAND USE PERMIT APPLICATION—Burnett County,WI t D <br /> Applicant Complete All Sections Below This Line a w <br /> Permit Types and Fees:(Please,check appropriate boxes) d fr— <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 fg, <br /> 11�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 $150Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S' <br /> Filling/Grading $150 Boathouse $500 �, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 z <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <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. <br /> Property Owner's Name: board wit WI �t 4,1 i i ' $ o <br /> t,Ln <br /> Property Owner's Mailing Address: 340 I I r b7 Cow/ l0} t0 n?v 0)5'`11. i i I 5940 1 n <br /> __ City State Zip E r_ <br /> 2$/75 k n S/' 11. 1�1�5n(;ll SC C <br /> Property Site Address: �'�I w 1 o e <br /> ' 7/5'S98—Jig z a <br /> Contact's Telephone Number: a- <br /> `� <br /> Contact's Email:,,�Oi n boe,j,„,y,y;c ya h(4 •GO41 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N '11 <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and o 00 <br /> 5' <br /> @BurnettCountyWI.gov 00 <br /> t.Legal Description of Property: \`;l ici e,. Q' /&i1I o l.)I Q�Q. `O i it Z 7 t' �✓M K 1 / • <br /> 7 <br /> Section#: 20 Town#: G, N Range#: ltor W Town of: -k/4-4 CF <br /> *Attach additional page if needed for lengthy description OR attach/��a copy <br /> of the deed OR attach tax system properly page.* E <br /> Tax ID#(1-5 digit number;found on tax statement): / / Q ,7 <br /> Proposed Use of Structure/Addition: End 05c o? 57e i-c €f Cci' 41 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C lV <br /> BuilblhL hw4+c./ s' r'e. ,ixittio, , �'U%s co ineifo'fj.a '54:rz' f, O C <br /> ding Contractor: Sewer Installer: tZ <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 /> •M�,e-. ca U st-Ooac-k-S s- <br /> • NOS -b xciebd 6o% q - s4riAdurcut corn .•n"-s <br /> Fee Rec. gs!i:ti• r/ I,�. , evli 4 Check#: <br /> "C� rlw►r` �, <br /> Z <br /> z <br /> 0 <br /> cA <br /> rn <br /> Date of staff site visit: q//q/20Z3 Initials of site visit taff: < —^—= <br /> G{� r r <br /> APPROVED BY LAND SERVICES OFFIC ATE: j ZZ v' Q- U u <br /> a m co E <br /> UPON APPROVAL: APPLICANT MU T POST COPY OF z3 C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o C <br /> Page 1 of 5 2 1 o <br /> Burnett County,WI Land Use Application—Rev 5/2023 a <br /> J <br />