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LAND USE PERMIT APPLICATION —Burnett County, WI cr g <br /> Applicant Complete All Sections Below This Line i <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 q-1/F <br /> )(Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :-7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk )( Bunkhouse_) 250 c <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 - r <br /> Filling/Grading $150 Boathouse $500 C4 ti <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `< <br /> b , <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. P <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a z . <br /> 0 <br /> Property Owner's Name: -D-145-6 AI U Ef.o(Ck o <br /> Property Owner's Mailing Address: (3$B y 3 7 c€ ST LEET /�onil%s„,,,,,ek Ai iJ ScoSG w tv <br /> City State Zip ° c <br /> Property Site Address: 9aS7 4 Sw APSO,Y Zoftd 6o.a•.Asb,..a.5 OM. 5 y840 o <br /> Contact's Telephone Number: 74 3 -?13-34 3 a, d <br /> Contact's Email: af eu‘&E.uEtLc y/g6Oo.Gorh. <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 mails from the following addresses:@BurnettCounty.org and (To ci'' <br /> @BurnettCountyWLgov A 'i J <br /> Legal Description of Property: Lit1 Gsr^ t b19 Vat 5 P 75- Rec_onob AS Doe.a016a Lert77. 1' <br /> Section#: a.5 Town#: 3 g N Range#: I a W Town of: (Jabot R;o Eit_ r„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* — ( 5 <br /> Tax ID#(1-5 digit number;found on tax statement): 9a 99 8 <br /> Proposed Use of Structure/Addition: ACC SSoa-y Si'euAe-it• *.L J e i <br /> Anticipated Start Date: /VoiEi.b a n 1 2h g (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .-,D <br /> 00 op <br /> Building Contractor: Ape(;cokes t" Sewer Installer: NVf} <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: 1 <br /> 00 <br /> *see. Gi clA►'►'�R�'1 - 61 Cp, .i-h�ls lie - is /a40/ li <br /> #250 <br /> Rim rt s Fee Rec4i: <br /> ui <br /> a Check#."' ` <br /> ri <br /> 398c) <br /> z <br /> Date of staff site visit:11 i 11Zo2 j Inifals of site isit staff:`f 6— C:: <br /> �^ c <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: G(J a) <br /> cr7 <br /> o c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF `— ® 03 <br /> IW N a)SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 g <br /> mci, <br /> Page 1of5 iji <br /> Burnett County,WI Land Use Application —Rev 5/2023 ='C11) <br /> Z <br />