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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> a <br /> b <br /> Applicant Complete All Sections Below This Line o' c w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> a <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 43 O <br /> <i Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 3.3 g <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 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 7 <br /> iv <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> -e <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 �" <br /> P rry �f J. ./ -/ // �744CEk c g <br /> Pro e Owner's Name: -aF.`.=r,'"- J. �', <br /> 8. <br /> -10 <br /> Property Owner's Mailing Address: t✓11/.4 `/31 fh S / /_7//k.>c•.44 14./1 5-1/ // a „� <br /> CityState Zip k' t`v A <br /> Property Site Address: .2717L ./ I (e,4n4,•sS L4 � X[d /�4 ti.fe (;✓r J y e93 c `"' <br /> o <br /> Contact's Telephone Number: 7/S 5--.19- 3.4 4 4, a k <br /> N d <br /> Contact's Email: I E /'f q cv c:`( ,404. - ('v H �° <br /> **If staff has a quYstion about this application,you will be contacted via email. Make sure your email address is N t, <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °a °C tv <br /> @BurnettCountyWl.gov go <br /> o W <br /> Legal Description of Property: Le l'3� S 51..`/ i��/:j 9 P/J Je c s/7)i'///G.�".'iit ii) N <br /> Section#: 3 S"*". Town#: A/O N Range#: /4, W Town of: 04 k I n j <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W o x <br /> Tax ID#(l-5 digit number;found on tax statement): .?L /`1'/ d <br /> y o W <br /> p <br /> Proposed Use of Structure/Addition: L u/d 51.:.0•9 '1^ <br /> Anticipated Start Date: ^. / / 2 L2.1 f (Home abin;Commercial Business;Bedroom;Deck;etc.) <br /> , E ..., <br /> Building Contractor: C/64.e Y Sewer Installer: ^//4 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 10 P&+ <br /> tc kS6 T lei S-ft� 0�1� <br /> Nod -bf f y <br /> D— <br /> runtivf--ei el tau-in i+-k-d 19k/ til l l`Wzy <br /> x Fee Rec:7,/5 V <br /> 'eve Shed -1-1) — d Check#: 417076 <br /> m <br /> r <br /> i. <br /> y/ m <br /> Date of staff site visit: 12 19]2023 Initial of site visit staffer-E < <br /> Hill <br /> APPROVED BY LAND SERVICES OFFICIAL:/ -(QA1-D DATE: I2/Z0/202,3 N = CJ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o g-i <br /> r' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTS 1� < <br /> Page l of 5 < � `'' <br /> Burnett County,WI Land Use Application—Rev 5/2023 ' , , <br />