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if, AP pe,,,,„4 (,) ..c, . <br /> y AND USE PERMIT APPLICATION-Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o* co i <br /> Permit Types and Fees(Please,check appropriate boxes) °' <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C \ O <br /> 1 4ccessory Structure(Garage,Shed,etc.) $150_ Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Ga <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 , �! <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `$ 'e <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. § (\ i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. "' <br /> z <br /> Property Owner's Name: rj i ( LCXZ(e- DP-CUS o .1 <br /> a. <br /> Property Owner's Mailing Address:U-173 S 1)=- A T yufu /6.F- 9-3.3C-3 (-) ON i <br /> City State Zip <br /> Property Site Address: 5 i�M L <br /> o o <br /> Contact's Telephone Number: 4e,S7— ,act.7- /4-4-ll e <br /> Contact's Email: it-t - ''Y-- ►- /CJ/9 U c '' yf4"1-f Lv -<=c ,62.4 <br /> **If staff has a question about this application,you will be con acted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov = °Q obi <br /> uo <br /> Legal Description of Property: L.0 17 C.5 l'Yl✓mil P 1 C`t CPtJ �, i L-t'T'5-, d o0 C7 <br /> Section#: I r-il Town#: 10,A N Range#: I(„ �t4k <br /> W Town of: C (6rti� �' -fi <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* -Njcn <br /> Tax ID#(1-5 digit number;found on tax statement): i ,3 ). ' i <br /> Proposed Use of Structure/Addition: S R_/ c ' �is, - 9 C/1 <br /> Anticipated Start Date: .3iOL / " ;4L, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> rc cJ <br /> Building Contractor: S Z—{= Sewer Installer: A/- y 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 8 <br /> w <br /> @IVI-tv otAit Sk-Vbauk <br /> N <br /> N1/-1- C , -I �` Woi-ki--ien y�I U M.Q lvl Fee Rec:1 'Y� <br /> . Check#: ifl <br /> r7i <br /> CI <br /> Date of staff site visit: S/2312021 Initials of site visit stafff r•F-CAL- Q �-�`-�� <br /> APPROVED BY LAND SERVICES OFFICIAL', / __i` Vh 7 DATE: 5/3/ 20Zy m c° 0 <br /> <.3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y �, U� <br /> 00 o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q <br /> ffil <br /> Page l of 5 co <br /> Burnett County,WI Land Use Application—Rev 04/2024 JJ <br />