|
`4V
<br /> LAND USE PERMIT APPLICATION—Burnett County, WI b
<br /> Applicant Complete All Sections Below This Line 5-
<br /> = IN)
<br /> co i
<br /> 0.
<br /> Permit Types and Fees:(Please,check appropriate boxes) d 6
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ o
<br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g
<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 z
<br /> Filling/Grading $150 Boathouse $500I.'
<br /> Ili r
<br /> Permit Extension(1 Year Extension-Allowed Once) $100 '
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee.
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o
<br /> t
<br /> Property Owner's Name:j)etr,tE L, iv;ell Sr t-
<br /> F.. n ,
<br /> o
<br /> Property Owner's Mailing Address: 222-5--- ( w7 , I/W aRli /ilt k 4 j figs' O E
<br /> y City State Zip c y
<br /> Property Site Address: 220 Z3 CdiUi% ;\7'ad'(f(4 6Wie 7:37,gII,eg.- WZ 5 5/8fl% . g
<br /> Contact's Telephone Number(')/S0 4/3/— C2 , '"-- we
<br /> Contact's Email;�L,%4z/1'N1 Gr)///z.f eDy! N e
<br /> / 7 eF'Sdofp3'/84, WOO 2/ G/�/es o ao
<br /> Legal Description of Property'g o1 GO✓.' I e'r Z<�r�� /0 etc. ,Dpi, 3 74'/8/. 6 ei 2)£.Pf °°
<br /> 111 d
<br /> Section#: 3� Town#: , 38 N Range#: /3 W Town of: to/ODD i FZ. q
<br /> s'
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.
<br /> H
<br /> Tax ID#(1-5 digit number;found on tax statement): 2 9`t""/$ 0 ;6,4
<br /> kp d
<br /> Proposed Use of Structure/Addition: jr, i;t(i. f / �r :�/Igr�/c1i
<br /> Anticipated Start Date: .1-,Z /$— „..'..2. (H Cabin;Commercial Business;Bedroom;Deck;etc.
<br /> /F,ccs/4/a? L�_rv57y//e 1
<br /> Building Contractor: s '; !. PX ' • ., ewer Installer: 4e,b,,er6f /$O#S-/L'-Oln
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zx ,
<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
<br /> home additions,and bunkhouses.** ( ( nl D S�v eS .¢,,;Me
<br /> I 2 ,p se-�fG --/6".C41- 'R oM fro RJ w Cc/ erl,'rte�a� ,r Gc ant o'
<br /> 'Nole-:SII Seitk&zlwve5 ° -!'h;S I-e4 !+e- nod-4./ lutoul h d/l ,'
<br /> $1.06....,5, d( IIVA,c(I� ?erm,f ,. needee( i� a Stud is /) .?J used 4em
<br /> s s . ' o
<br /> Date of staff site visit: A/S/? Initials o s v' •� sta•• , L Fee Rec: 15 c 1?i)—c Check#: 1 ?
<br /> APPROVED BY LAND SERVICES OFFICIAL: `� ' i' 1, DATE: 2'11 v/?-
<br /> 2- �oJ
<br /> UPON APPROVAL: APPLICANT UST POST COPY OF a ..,., Cart
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m
<br /> co co CSS
<br /> C ' Y�Y
<br /> Page 1of5 �g N
<br /> Burnett County,WI Land Use Application—Rev 12/2021 aro..2. N.,
<br /> LEJ
<br />
|