|
LAND USE PERMIT APPLICATION—Burnett County, WI cr
<br /> Applicant Complete All Sections Below This Line 74'g CD o
<br /> Permit Types and Fees:(Please,check appropriate boxes) CDL. �--
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 B. .-1)
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C `J
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 L
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350
<br /> Filling/Grading $150 Boathouse $500
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100
<br /> •
<br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. • c
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a
<br /> .:' „,"
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.
<br /> Property Owner's Name: 3 \t ( s e{r e) r 1.-,
<br /> Property Owner's Mailing Address: 8Z P,�/ir� f- Ds N ikotSU>'1 Lt' SVCl 4 ° ) r
<br /> City State Zip a.
<br /> Property Site Address: 32?-6o SC7t,e_4kShe rr. 'LI ..
<br /> = nW
<br /> Contact's Telephone Number: (9$i- a2-)cC- /peg- _o
<br /> 0 CD
<br /> C.
<br /> Contact's Email: ;,kl h.ess-e le 01-t• di. 11030,4A.. ( , Gyro d
<br /> CD
<br /> Legal Description of Property:
<br /> N -o
<br /> Section#: Town#: N Range#: W Town of: ° (Jo
<br /> s.
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q
<br /> Tax ID#(1-5 digit number;found on tax statement):
<br /> Proposed Use of Structure/Addition: C`,.Ls" bL,,,,,k,,vulk, cn
<br /> Anticipated Start Date: ,/Q/c/ Z© (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) I
<br /> Building Contractor] r 61,4// /JGt;/dtv CI,-t
<br /> Sewer Installer: t crit-k tr<S H C_..-
<br /> % SAREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to O
<br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z
<br /> home additions,and bunkhouses.** %v
<br /> .-4;7, Ca ,l U,T N, Co.(\cl-Ci-k ON", d=73" cp4, pec TYIA s; l,Li 'c 6-557
<br /> __. E it,IA,3 ( -tr hose l 1 ne,Per L u • /LI- (i61.. OAP elks Pi-Y6'.
<br /> Record Loc,c15 l Ford( ��q ,
<br /> 1 x Fee Rec: rav
<br /> --T> R ►o,�� AAA Ke A (eewte�t- b,., Abu,call Per Cu�°01D^�S�f" Check#: !oZ//e .
<br /> Date of staff site visit: "--1 9'..--. Initials o site visit staff: N(--- tria
<br /> Z
<br /> �''"'� ]
<br /> APPROVED BY LAND SERVICES OFFICIAL: c-0- ------El'An:/0-C)Cr--( r
<br /> <
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �aEi
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . m
<br /> O o
<br /> Transcendent: - Page 1 of 4 m g^ a
<br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 < 3``
<br /> Cl�1U
<br /> V
<br /> i
<br />
|