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DocuSign Envelope ID:30FBDCA9-F787-4A8D-B9C8-444DE12E658C <br /> LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line0 VD <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ) 0 <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� v <br /> x Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o lb <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> iv 1 <br /> I <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. - 0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. t- @, �� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> ~n r <br /> Property Owner's Name: NORTH CAMP PROPERTIES V, LLC 0 <br /> 0. <br /> Property Owner's Mailing Address: PO BOX 66 DANBURY WI 54830 ' <br /> 29221 HAYDEN LAKE ROAD DANBURY WI 54830 tyState Zip <br /> ° g <br /> Property Site Address: <br /> Contact's Telephone Number: 715-204-4043 c . 9 ` - e <br /> Contact's Email: <br /> kellee@northcampproperties.com J t�� <br /> N b <br /> 5 <br /> Legal Description of Property: Lot 1 CSM 4945 V27P306 DOC461558 ao <br /> d <br /> Section#: 05 Town#: 40 N Range#: 16 W Town of: OAKLAND 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> a, <br /> Tax ID#(1-5 digit number; found on tax statement): 35424 Q o <br /> (}) <br /> Proposed Use of Structure/Addition: 10 x 24 Deck. 8 x14 Storage Shed d <br /> Anticipated Start Date: 9/9/23 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .-I <br /> Building Contractor: Existing Structures Sewer installer: N <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from theta prior to xl <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured 6.'� <br /> home additions,and bunkhouses.** <br /> Fee Rec: 1c254D <br /> / f—, Check#: <br /> Date of staff site visit: 1 2 r /G IZ C 2? Initials of site visit staff: f T <br /> a <br /> APPROVED BY LAND SERVICES OFFIC DATE: I 00/202S VI <br /> r =�=1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m a cn <br /> m ngliii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 5 CD <br /> v2r c=a <br /> Page 1 of 5 w <br /> Burnett County, WI Land Use Application—Rev 05/2022 < m Eilfil <br /> _ L� J <br />