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LAND USE PERMIT APPLICATION-Burnett County, WI b <br /> Applicant Complete All Sections Below This Line _ w <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c p�p�� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .eD F N <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ���jjj �J <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> v: <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> ; <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '7'.' <br /> *Communication Towers,Camping Permits&Sign,s require a different application form;see corresponding application,and fees. <br /> pp <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z 0 <br /> 9 <br /> Property Owner's Name: D 1 E.i� G T .� <br /> Property Owner's Mailing Address: Id�lt,moIE, 'S G.,19, r ti,Qpi4J/.' 5130 r '-UN <br /> , <br /> n City (State Zip y 3 <br /> Property Site Address: ,4 C c� <br /> Contact's Telephone Number: 7/ —J�� 1yr"�&✓ L - .' 0 <br /> o r— <br /> Contact'sEmail: .lLor� &/niii DIV 0 r <br /> **If staff has a question about th s1 appli lion,you ill a contacted via email. Make sure your email address is 71 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and - <br /> @BurnettCountyWi.gov <br /> o P1 <br /> Legal Description of Property/}, I C54i 5.2 q7 Val 30 P1?-3 k corded aS at llIll; /FT �1" <br /> Section#: lc. Town#: I o N Range#: I W Town of: Jac <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* b x <br /> �(8 <br /> Tax ID#(1-5 digit number:found on tax statement): 3� -" 0 <br /> Proposed Use of Structure/Addition: 6 'C ck vV'�' <br /> Anticipated Start Date: CY.,I c t..Q� > (Horne/Cabin:Commercial Business:Bedroom:Deck:etc.) - (�_� <br /> Building Contractor: 4;n'- C t-1Jr-‘ Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x • <br /> THIS PERMIT IS SUBJ CT TO ALL CONDITIONS LISTED BELOW: 10 <br /> CT <br /> Akirler kftt 6 <br /> z Fee Rec: //5 <br /> o Check#:_;__=_y <br /> m <br /> z <br /> 10 m <br /> Date of staff site visit: !q / d� itials of si a vi t staff: ddi::: r==-.^- ----- <br /> Fs a 'n <br /> CO <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 1/ /2.3 y m�° M n <br /> > < = 'D vU <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Q ci, = [rill <br /> z C7 oo = <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o w Q <br /> Pagelof5 < m MI <br /> Burnett County,WI Land Use Application—Rev 5/2023 a � )J <br /> -. <br />