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LAND USE PERMIT APPLICATION- Burnett County, WI a <br /> _ Applicant Complete All Sections Below This Line b-' c c <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> p C7 ...6":4)- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> co <br /> . Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150G1 O <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 cp <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o C1 <br /> Filling/Grading $150 Boathouse $500 r. <br /> in Unit(One Per Year) ° <br /> Six Month Camping g $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 1 <br /> c., t <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> Property Owner's Name: g 1 cV101cAs -C P kr)A rem„ ;6:,_612.k.1 ° z iv, <br /> P 44 <br /> � . �? <br /> Property Owner's Mailing Address: [..'"1 LAl2Z \ Or\ 2-4 1, -,kcr- : 3 o <br /> a. <br /> fi 1 l City State Zip <br /> Property Site Address: =• r <br /> Contact's Telephone Number: -1 l S- " S-2-0 - '1 I S-`A __ o pm <br /> a. i <br /> Contact's Email: (\c,RASA, 1 OCA <br /> (3t'Ylo_: . � ,rr) <br /> , ) d \ <br /> Legal Description of Property: -6\' C-S V\ V if @ 511 Com, L it 2r1.5.0)-‘i ,-.., <br /> N `u <br /> Section#: ''. i.-k Town#: Ll O N Range#: ) Li W Town of: Scott ° °O <br /> E. <br /> ac <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> EF <br /> Tax ID#(1-5 digit number; found on tax statement): k ca"-)9 2_ ,a <br /> Proposed Use of Structure/Addition: S ha.CA ( S*pre .9CA <br /> Anticipated Start Date: R1 rer. y „,..A-t, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> d <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (Th <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their CDC Inspector to determine if a permit is needed from them prior to II <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** ' � xt <br /> --- ' )�d ecC in1Q(7 t 0 �t�1I�T'e!q <br /> S 'b GliovJe <br /> So e o n Mods . NO f <br /> Fee Rec: <br /> �5 <br /> Check#: '61 <br /> Date of staff site visit P- 3- --.;,„_,I=2-:-___ Initials of site visit staff: z <br /> x <br /> APPROVED BY LAND SERVICES OFFICIAL:�,l"ae��l� DATE: i� <br /> -I�c� i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> ca. <br /> T © <br /> 1- 3 zl�i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT as IV 1 <br /> G, <br /> Transcendent: - Page 1 of 4 T w � <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 3 0 �'; <br /> K <br /> Lc 2) <br />