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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line " cn til w <br /> Permit Types and Fees(Please,check appropriate boxes) C <br /> Dwelling/Principal Structure $300 7, Addition/Alteration to Dwelling/Principal Structure $200 co, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <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 0 II <br /> E <br /> Filling/Grading $150 Boathouse $500 c <br /> w <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. <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. c <br /> o r <br /> Property Owner's Name: ij?,✓ j 4,0,1) ,4)/e.7 hrl%t,✓ o ~— -- ^ <br /> °n. Z I <br /> Property Owner's Mailing Address'"5/ Ii/t5( 77 ii/c-!.S Pe L-7 j?Ai Nz 4-1 >372 j 4. <br /> City State Zip C <br /> Property Site Address: C 7/ /�� /L S/ 10i9-A),.3iif( /j.11 112-/ ?ti o y t` <br /> Contact's Telephone Number:a%7 5 L'`f 5Gy 77 [v °' <br /> 0 -g <br /> Contact's Email: /� � iyLr<&ZC t��si,',?. e,PIA— `. <br /> **If staff has a question about this applicatidfi,you will be contacted 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 g 5" .--0 00 <br /> @BurnettCountyWl.gov I <br /> r <br /> Legal Description of Property:J`�St-hi I�4"S //' AltLi/' 4tk %�t l,4/Lt � ` r/ 6- <br /> Section#: // Town#: tilt° N Range#: //, W Town of: Gj ii/i f-,,) , ) v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> —P d <br /> /�/✓ <br /> Tax ID#(1-5 digit number;found on tax statement): / t,✓ I0 0 <br /> � y <br /> Proposed Use of Structure/Addition:iQ PO /)-'�C i 2 ' deck . A eya-✓D Ale F C9Y'L,'1 Q--Zfc "C <br /> Anticipated Start Date: J)L Y 2 '2 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc) .. " <br /> Building Contractor:40 pC:3b/v C 47t.c;T;z a- iid.: Sewer Installer: 0 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> d NV- aki Sep i S <br /> x• Fee Rec: ," CO <br /> ✓• Check#: 7 / t(5 <br /> m <br /> r <br /> a <br /> z <br /> !r o <br /> Date of staff site visit: I 2ll11/2oZ' Initials of site visit staff:— ' < r �� <br /> w <br /> APPROVED BY LAND SERVICES OFFICI r DATE: 12�5 cn . v 1511 <br /> CD UPON APPROVAL: APPLICANT MUST POST COPY OF o C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 0 o <br /> Page 1 of 5 < a`` Go <br /> cri RI <br /> Burnett County,WI Land Use Application—Rev 5/2023 u <br /> I <br />