|
w t-
<br /> LAND USE PERMIT APPLICATION-Burnett County, WI 5-
<br /> -73b
<br /> o
<br /> Applicant Complete All Sections Below This Line
<br /> P re mit Types and Fees:(Please,check appropriate ,�
<br /> yp boxes) _ _
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ='
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200
<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
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 . C
<br /> o w- I\.
<br /> Filling/Grading $150 Boathouse $500 : b \J1
<br /> Six Month Camping Unit(One Per Year) $100 )( Permit Extension(1Year Extension-Allowed Once) $100 '
<br /> s
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. rzn
<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.
<br /> Property Owner's Name: A'a.rI •SiGC et ' g.o
<br /> Property Owner's Mailing Address: ,5 ,)C A...7.."-i- ,4'e. &,&Ilhfh ) .5.3-0 T 2 oe
<br /> ` �
<br /> City State Zip
<br /> Property Site Address: ) 2 �Z / /b‘tled. 5 PVile)"
<br /> Contact's Telephone Number: C)2--g�s^3323 0
<br /> Contact's Email:
<br /> Ci,e ,03 0 Corc&f�• e 0.
<br /> sz
<br /> Legal Description of Property:JoE / (,.sx`# .25 1/2/ 4208
<br /> Section#: c5.-_Town#: _N Range#: / X _W Town of: Scott
<br /> *Attach additional page i/'/ceded for lengthy,description OR attach a copy.of the deed OR attach tax system pr'oper'ty page.* V
<br /> 4.
<br /> Tax ID#(1-5 digit number: found on tax statement): ,�,2,�3
<br /> Proposed Use of Structure/Add.tion: akj�
<br /> Anticipated Start Date: jtre�'9 (Home.Cahn;Commercial Business;Bedroom:Deck:etc.) y
<br /> i
<br /> Building Contractor: /ll eo t.r'h�, i m� Sewer Installer: —
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (",
<br /> N
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> i!,,,„ppii,,, . i'' ,/, ,,in:i,t tit Cif' l 1)t It,,pet;. r ta'te'r F `,L,it fTtti i i fnt'e er tt,:.i,t ;,. SFi r'r*.:."
<br /> r
<br /> ; .';1' ';I'd 1 I -.'."r I.ih' pro. '!to +raj' t s:l/,r7y c, !,.'t'i"tu.`'at</ai£?•rs, ., .:nttjtt.tt r.,f !!mo,-'0, r 7,.',/d,•-. 'tut Z
<br /> . '1-1Ft'tits:,.-,', ,ifPtf. .:tikh,,=it.c,., 7.
<br /> - Fcc Rcc:t
<br /> Check#:.7
<br /> P
<br /> n
<br /> 4)4
<br /> Date of staff site visit: nitials of site visit staff: rT�—
<br /> APPROVED BY LAND SERVICES OFFIC DATE' ?.� —�-
<br /> J
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OFlifd
<br /> W
<br /> T c
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N 0
<br /> o0
<br /> Transcendent: - Page 1 of 4 w Q
<br /> Laserfische: - Burnett County, WI Land Use Application —Rev 6/2020 3 _.
<br /> •J.
<br />
|