|
LAND USE PERMIT APPLICATION - Burnett County, WI .
<br /> .-
<br /> .,
<br /> ,.
<br /> Applicant Complete All Sections Below This Line a'•
<br /> n i
<br /> a.
<br /> Permit Types and Fees:(Please,check appropriate boxes)
<br /> '417 i.E3 1
<br /> Dwelling/Principal Structure , $300 Addition/Alteration to Dwelling/Principal Structure $200 w
<br /> 0
<br /> Commercial/Industrial Structure ,$300 Addition/Alteration to Commercial/Industrial Structure $200
<br /> T..0
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 --k•-•; Po
<br /> R
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o
<br /> :!r
<br /> Filling/Grading $150 Boathouse $500 FT
<br /> o: ),)
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 %
<br /> ,
<br /> o
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. z.
<br /> a
<br /> *Communication Towers&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. '7)
<br /> co
<br /> ,
<br /> r. III
<br /> Property Owner's Name: 64,ev.',- i-- '64 rbcior q St li ati ev,c 0 .....
<br /> c,
<br /> Property Owner's Mailing Address: il %0
<br /> 12614 SiL AI ,t)i,ile ile'r.-vv1.5-37/0 QT CI
<br /> 4 /
<br /> , City State , Zip .to
<br /> Property Site Address: b '.7 e12- 711/,/1)(-4-vo'd
<br /> ),.17 f/ "e'r'-' tAii 51<e22 1 n
<br /> cn IQ
<br /> P
<br /> c, ,
<br /> Contact's Telephone Number: 67,..s7 --- .?-30 -,c), /- 4.___ --- F
<br /> ,-, ,7:=> • 2-
<br /> Contact's Email: K 5.e ha tIle,C .1 it.. c../ 4a---
<br /> ,
<br /> e-,5 in itie az& v v I'Vt V FO P
<br /> Legal Descrigtion of Property.
<br /> . tvr f 4_7 6.f'nt-rs? 324-v4,1,O 3 N
<br /> , t •
<br /> .r.z..7 -0
<br /> Section#: Town#: 3A N Range#: ,4- wi--cr wf: irj o% e-",e1,,D"Ni 0
<br /> a 70
<br /> 5.
<br /> 0'0
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed.OR attach tax system property page.* P rs1
<br /> =.
<br /> Tax ID#(1-5 digit number; found on tax statement): R ',." 73 'i-- )2t
<br /> 4 ,
<br /> 1
<br /> -"if iti- I—
<br /> Proposed Use of Structure/Addition: /910F/Hv5 19 m-- ii-imele .1" ,- 7 fr 4.--V4S Exf."4,e4
<br /> Anticipated Start Date: jvi ?epi4 (Home/Cabin;Commercial Business;if edroom;Deck;etc.) i'll'`9 ij
<br /> A 4i L 0
<br /> Building Contractor: fi 0 ei e • (.4./Avi( Sewer Installer:
<br /> .-.3 .......
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ! 's..1
<br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to ci•J
<br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z
<br /> home additio.1;11nd bunkhouse§.** m
<br /> hi .
<br /> it.i chwil OA 5e c. igAt5
<br /> 3 CerFirl-- 5drUey 4.2? be 300e 1901, IA 2-) 4r2 J " Ws,
<br /> ,
<br /> = Fee Rec.
<br /> .-L.--
<br /> -
<br /> c.c. Check#:_Zblq
<br /> to
<br /> t-.
<br /> Date of staff site visit: 6 i d-/ d---i Initials fsite visit staff:
<br /> .. ... „./
<br /> DATE:6(4 ii2"-1 r-
<br /> so
<br /> Nil
<br /> APPROVED BY LAND SERVICES OFFICIAL: / /7 =
<br /> a x
<br /> UPON APPROVAL: APPLICANT ST POST COPY OF
<br /> 1 g (5
<br /> Gill
<br /> (..12
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT
<br /> Transcendent: - Page 1 of 4 U
<br /> a. Ea
<br /> Burnett County, WI Land Use Application —Rev 12/2020 =
<br /> Laserfische: -
<br /> "
<br />
|