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UA It <br /> LAND USE PERMIT APPLICATION — Burnett County, WI CD b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and FeestPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 > �o <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 s CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 v% T <br /> Driveways/&Campground Structures $125 IWI State Statute 59.692(iv)Structures $350 0 ( <br /> Filling/Grading $150 lBoathouse $500 v, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-tact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 "' <br /> z <br /> 0 <br /> Property Owner's Name: GIB 0 1 <br /> Property Owner's Mailing Address: NG I LrC � 4 <br /> n <br /> 1� C' + ,�/j t ._o Zi (— <br /> Property Site Address: ( �� 1�)t r�-��Jf b(A21j �c qY <br /> Contact's Telephone Number: " J0 t 'd <br /> Contact's Email: <br /> **If staff has a question About this application,you wi a contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov °Q <br /> R. <br /> IQ <br /> Legal Description of Property:CVM&AAoK eC_ S14/A!S CPtA d <br /> Section#:� Town#: N Range#:__A6_W Town of: 61,X-101 t ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> 3 SB�sTax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (HomelCabin;Commercial Business;Bedroom;Deck;etc.) O <br /> a <br /> Building Contractor: Sewer Installer: y � <br /> D <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY M z <br /> THIS PERMIT IS SUBJECT TO ALL COND�ITIONS LISTED BELOW: o M <br /> Sum �mt���fal�► oIm 4�� S (�I7� 727nA-1- -7/J1zozS, � s <br /> 0 Co Ko(o P47' 7�1 �e V�► r vtQZ_� loy !Zl 100 fo r <br /> rA <br /> Fee Rec:l,/Ll/'7L' #s^ s D �"�P e.>r` z Check#: <br /> ew�ce � ✓e�nlL-� ac«esS Is a1/nL,�eo� 74o cG6 A4S <br /> ew►otie— VIH ►hole-�^S ycM of�-R Pew�lSe 5/�l� of Couu/f�aq y P �#e_ AV v <br /> by �r�/zagsCA <br /> Date of staff site visit: S g ZOZ� Init' is of 'te visit staff: n <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z �° �x <br /> UPON APPROVAL: APPL ANT MUST POST COPY OP 3 <br /> C ^' <br /> 00 <br /> -0 C. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCID <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application-Rev 11/2024 <br />