|
LAND USE PERMIT APPLICATION— Burnett County, WI a
<br /> Applicant Complete All Sections Below This Line 5 o
<br /> Permit Types and Fees:(Please,check appropriate boxes)
<br /> P ,,-_,- ,F.
<br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $20000
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
<br /> G7
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 \
<br /> Filling/Grading $150 Boathouse $500 , C-
<br /> Six Month Camping Per Year)g Unit(One $100 Permit Extension(1 Year Extension Allowed Once) $100
<br /> cn
<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. -0
<br /> /� r g le
<br /> Property Owner's Name:
<br /> ---re rJ" r�, y �C v TT /✓ /, �/ /4 ° z,,,,.j t
<br /> �
<br /> o
<br /> Property Owner's Mailing Address: 82 1/I4P/e ,S�'-►-ee%/ 1,41'l D,,-3 /:4911 nr Stv Y(4- ;LIo 0 t
<br /> a.
<br /> City State Zip
<br /> Property Site Address: 9'y 9- ge ty/� gd, / �i Qui W 5 1 c 9--i
<br /> Contact's Telephone Number: 4 C.t- y/' . N
<br /> _
<br /> e _
<br /> Contact's Email: -.) 1 int go a u e' re` 60'It
<br /> a
<br /> of ,c,s vi C2.0 >? /9- ti/ .9c;2es s c d
<br /> Legal Description of Property: A 3t - /7 .20 / 03 0000 I.,c o jq/l/a k/& l y .'w N t
<br /> N -v
<br /> Section#: 1a Town#: 3i N Range#: l7- W Town of: 04/0-z,, = Q4
<br /> `*Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system propertyPage.*
<br /> p
<br /> Tax ID#(1-5 digit number;found on tax statement): 3q
<br /> ,t., ,
<br /> r cn
<br /> Proposed Use of Structure/Addition: D i,,,
<br /> Anticipated Start Date: .15/9e (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x
<br /> '( C7
<br /> o
<br /> Building Contractor: in fiN 1,1,�/}G Jv✓� (/�✓It, Sewer Installer: i.-:y t Sft�ll
<br /> I -1
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY k?
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> **The applicant needs to contact their LDC 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
<br /> home additions, and bunkhouses.** x
<br /> /3G pifor fio ,A& ) boyn e heft, place-ado "
<br /> M,, r 3 bed roo fv� —
<br /> die x Fee Rec:
<br /> c i .2\\\ .`' t y
<br /> Check#: �l'�
<br /> Date of staff site visit: _ Cr Initials of site visit staff: W---
<br /> , miz —. t......j
<br /> APPROVED BY LAND SERVICES OFFICIAL: MtklISQ.AnkflitkicbtiME: (V 1.---dt W CD �uB.
<br /> m
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OFtf�
<br /> '�O C7
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ":
<br />
|