|
LAND USE PERMIT APPLICATION— Burnett County, WI . ,°
<br /> Applicant Complete All Sections Below This Line 0 0 o
<br /> Permit Types and Fees:(Please,check appropriate boxes)
<br /> • d
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 x
<br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1,......,.. 2,
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250g
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0
<br /> Filling/Grading $150 Boathouse $500 C- p
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 p
<br /> c
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee.
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. $ j
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.
<br /> C i co
<br /> o E. r
<br /> Property Owner's Name: QAYl. J , ejn�r Re1\c e �CGt A ,.�le ii‘5041 z
<br /> 2
<br /> Property Owner's Mailing Address: 17 9 5 C -Tve,u1t r>;ii., O r $ n
<br /> `t.....,,t.....,,° � � 'JCity State Zip c
<br /> Property Site Address: a�� il•v— Vel i J b %,,*Contact's Telephone Number: "7 i 55'\ - �j'Acti. I. o
<br /> •
<br /> ro
<br /> Contact's Email: ,...r )... CI p,- @ 0...A . Com } d
<br /> Legal Description of67 7Property: ^ S t 9, 1 ---C,,%_-).,;;Y 5, ; s MAV
<br /> . oLsr VGt 1 \ 'it je v
<br /> Section#: S i ' Town#: ! i-t NN Range#: t� 7 W Town of: act cl '1 c °O
<br /> ID
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CM
<br /> Tax ID#(1-5 digit number; found on tax statement): 3546•,6? _ _ ,),•
<br /> Proposed Use of Structure/Addition: ck C.c Ll e- v,
<br /> y -i -I
<br /> Anticipated Start Date: Q13 -0.:6,- - 2,0).e.) 4-lame/Cabin;Commercial Business;Bedroom;Deck;etc.) o x
<br /> Building Contractor: e`oetz;r,1 Gat` .3e Sewer Installer: NIA
<br /> I ,-3
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> %/1 -,,)
<br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to
<br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z p
<br /> home additions,and bunkhouses.** 7'
<br /> '1c 6avar KO 10 be ttseeg lar Iucstmi haW brt.
<br /> ▪ Fee Rec: /
<br /> U Check#: 661/9
<br /> . '--------M
<br /> Date of staff site visit: ��i/2OZO Initials of site visit staff: z
<br /> APPROVED BY LAND SERVICES OFFICIAL ATE: 0)A,20 ----nrfifil:< c._ ~;
<br /> UPON APPROVAL: APPLICA UST POST COPY OF ,,-;; r-
<br /> w ifEfil
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ��'1cz' Q
<br /> Transcendent: - Page 1 of 4 x otiiiii
<br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 < C:::::=
<br /> >
<br /> K
<br />
|