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r a - <br /> LAND USE PERMIT APPLICATIt)N —Burnett County, Vb'I <br /> Applicant Conylete All Sections Blow This Line = G 1�t <br /> Permit Types and Fees:Please,check appropriate boxes) - I \ <br /> Dwelling/Principal Structure $300 Addition/Alt+oration to Dwelling/Principal Structure <br /> Commercial/Industrial Structure $300 Addition/Alt)ration to Commercial/Industrial Structure $200 1 e z <br /> dition/Aitiration to Accessory Structure $150 <br /> Accessory Structure(Garage,Shed,etc.) Ad I� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Bunkhouse $250 `,b <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk --- j <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Exter!sion(1 Year Extension-Allowed Once) $100*NOTE:After-the-fact permits(permit acquired after construction has begun);,tnay cost up tothree times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different applicaton farm;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:perg6rbs,landscaping,etc. z !� <br /> N <br /> Property Owner's Name: x IJ <br /> Property Otis ner's Mailing Address: ,; 1/37 f , icy <br /> Stat Zi <br /> R Cin° P <br /> Property Site Address: � � 3 7 9 <br /> Contact's Telephone Number: <br /> ov � <br /> Contact's Email: !'�(Vt�i kGCiyti l� �GVtFk _ 'vt,vt <br /> **If staff has a question about this application.} u«-ill bi contacted is email. Make sure your email address is N <br /> legible and your email proN-ider«ill accept emails from the folloviring ddresses:aBurnettCountv.org and � 4- <br /> a;BurnettCountt-WI.goN' <br /> LIU <br /> ;ai Description of Propem: O V - ° <br /> Section#: _Town#: `11Li� N Range#: W To n of: <br /> *Attach additional page if needed for lengthy description OR attach a copy o j the deed OR anach roc system property,page. <br /> Tax ID#(1-5 digit number:found on tax statement): <br /> Proposed Use of Structure/Addition: (�� I Z X 2co� A IW <br /> r. <br /> Anticipated Start Date: /, 5^ � (Home Cabin;Co ercial Business:Bedroom:Deck:etc.1 p I 0 <br /> Building Contractor: tee t tl t-��` t'✓�- Sewer; nstaller: &P !H" a -t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CC'MMENTSXONDITIONS ONLY <br /> z 'N <br /> THIS PERMIT IS SUBJECT TO ALL CONDI`rIONS LISTED BELOW: <br /> _W VG- itXrr Tb FXCJ2e-p q B pg0rjj.ts PEA S•q N <br /> f <br /> Fee Rec:��- <br /> f Check#: <br /> 0 <br /> z <br /> c <br /> Date of staff site visit: Initials of site :,isit staff:-j-:tK x a � <br /> C W <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 DATE: 9 `f ZoZS <br /> TTPON APPROVAL: APPLIC NT UST POST COPY OF <br /> SIGNED PERMIT APPLICATIC N IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County,WItand Use Application—Rev 3/2023 =� <br /> Gfr%d(lii �✓rf if� _. ,,,� Pam'' <br /> 4r� IS t'SS� .t�lr�l 1rLs�f <br />