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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 , <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ~ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G? <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 oy t, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> o <br /> Filling/Grading $150 Boathouse $500 ` <br /> w <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> iv <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <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. r.' " .,_, <br /> 2 <br /> Property Owner's Name: J4..,1c) ,AJc1sc.1 -, <br /> Property Owner's Mailing Address: , 55 0/5r,1 ot �'�IS v�- 5-3 / �. r? F <br /> G / City State Zip cn <br /> Property Site Address: 0(�C5- O(kn 1 / (�4�jS)�/ WJ_. / 3 r <br /> CD <br /> Contact's Telephone Number: G/0� — 6`f 7 — 4, -- 5 —5 ca. <br /> Contact's Email: h t C/5 c 4 tM /1 _ Witt:f . Ce'n'► <br /> **If staff has a question about this application,you willte contacted via email. Make sure your email address is N ,.d <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org ando 0° <br /> @BurnettCountyWl.gov // QQ 14 <br /> 7 <br /> Legal Description of Property: gb 5_S oisc.-t � I/ vf,4 L - .5- rer3 <br /> Section#: Town#: N Range#: W Town of: -A c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* , ' <br /> CJ <br /> Tax ID#(1-5 digit number;found on tax statement): / 0 5 O 6 ,, <br /> Proposed Use of Structure/Addition: _$9 r'ct y e -5 he`e t- _I1 <br /> ./ O <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 5 <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY xi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: J <br /> -w aa 560 c ( 5 <br /> 'Iak tb \Dt- if `1V Ak i,5,, <br /> Fee Rec: / <br /> Check#: ' 41 <br /> rr <br /> PI <br /> Firil <br /> Date of staff site visit: Co 1 ivllK Initials of site visit staff: �L Q. M <br /> '"��,,}},� 1 r 1 rn `(° co D <br /> APPROVED BY LAND SERVICES OFFICIAL: jtau�w l DATE: (lh)1 -< <br /> Y c: tea to u u u <br /> Page l of 7 a 0 o <br /> Burnett County, WI Land Use Application—Rev 5/2023 ' D3 Y ra <br /> n 0 � 1 <br /> tr 0 <br />