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• LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> IN <br /> Applicant Complete All Sections Below This Line a. c41. <br /> O. <br /> Permit Types and FeestPlease,check appropriate boxes) <br /> v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 E le <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 •ZN <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° �_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c....., <br /> o <br /> Filling/Grading $150, Boathouse $500 ea <br /> rn <br /> `? D. <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 _ is <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. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z Ci <br /> Property Owner's Name: A);-ii i et wt `1 o S 1 e G k� o o , <br /> ..� I.Property Owner's Mailing Address: ).g Cr o S 5 c. ti e h Q gezcP w <br /> tn <br /> City State Zip 4 <br /> Property Site Address: Oa vi b cc.r j kNi L 5 $3O o c, <br /> • <br /> CD <br /> Contact's Telephone Number: 708— .s i- 3© 17 a. <br /> ' 'CD <br /> aContact's Email: (9 kD S C1al` ® clip' , co„l <br /> p., <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov S °O <br /> Legal Description of Property: DM km-5 Cl KI Lc T ' cm <br /> Section#: 0 7 Town#: JO N Range#: /r W Town of: .Jac ks©yi o. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .etcn <br /> C o <br /> Tax ID#(1-5 digit number; found on tax statement): 6'). 6 y .1 <br /> t7 <br /> Proposed Use of Structure/Addition: 6Q r ' qc -3 G---- <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (J <br /> s O d' <br /> Building Contractor: tp It Co Sewer Installer: u, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> —ttAidk allSrprtSs, ietlSNlreNNaIS < ci6 <br /> ri <br /> — Nak \O \ve, \)SU- i6e \iumnr►a,^ 'Y A)O to In <br /> p� a � <br /> —<j( t, �+ \\ Ai) \Df. '` 4 41ck� 0, \6c&L Wes- P))naxv `D`1 0 15)Zt?2i'.` Fee Rec:f t — <br /> °z Check#:Oa* <br /> a <br /> m <br /> Date of staff site visit: L d ' ) Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: id 7Vv, DATE: 7/1/261.41 w W c n <br /> vv <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N <br /> 0o r== <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD c CD <br /> ro <br /> N <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 04/2024 0 <br />