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LAND USE PERMIT APPLICATION —Burnett Count', WI g P. N <br /> Applicant Complete All Sections Below This Line o [ 4, -c.... <br /> [Petmlt Types and Fees:(Please,check appropriate boxes) Z <br /> 1Dwelling/Principal Structure WOAddition/Alteration to Dwelling/Principal Structure $200 , `� <br /> Commerdal/Industrial Structure $300 iAddition/Alteration to Commercial/Industrial Structure $200 i Q'�1 <br /> Accessory Structure(Garage,Shed,etc.) $150 !Addition/Alteration to Accessory Structure ,$150 <br /> (Accessory Structure(Commercial/Industrial) 5200 }Addition/Alteration to Bunkhouse $150 :z <br /> Deck/Stairs/Patio/Retaining Wail/Sidewalk jBunkhouse $250 0 <br /> iDe <br /> 4Driveways/$CCampground Structures $125 !W:State Statute 59.t592(1v)Structures $350 i' ,- ...$° 1!t <br /> 1Filling/Grading $150 Boathouse $500 <br /> '61 iPermit Extension(1 Year Extension-Allowed Once) $100 <br /> 1 f. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. b .�I <br /> *Communication Towers&Signs require o different application form;see corresponding application,and fees. S' O. v <br /> i*hems not listed above wit/be treated as accessory structures,such as:pergolas,landscaping,etc. x <br /> North Camp Properties V, LLC UBA DuFours Campground i <br /> Property Owner's Name: .8- <br /> E. n <br /> 7 <br /> Property Owner's Mailing Address: PO Box 68 Danbury WI 54830 7` <br /> City State Zip < .- <br /> kY <br /> Property site Address. 29221 Hayden Lake Road Camp Site#: I , t <br /> Contact's Telephone Number.715-2044°43 N o \ <br /> Contact's Email: kellee@northcampproperties.com ! — F <br /> 0 <br /> Legal Description of Property. Lot 1 CSM 4945 V27 P306 o O <br /> Section b: 6 Town#: 40 N Range#: 16 W Town of: t?akletld t '.� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attack tar system property page,* <br /> Tax ID it(1-5 digit number;found on tax statement): 35424 ]D <br /> Proposed Use of Structure/Addition: __ Pl ir% I.;L ,4) i Q <br /> Anticipated Start Date A ;:-, 3. (Home/Cabin:Commercial Business;Bedroom Deck;etc) .-' <br /> ti/> —.C <br /> Building Contractor: ° ',1.g.j,1/[/, da` } Sewer Installer: C.J. . <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENI,'S/CONDITIONS ONLY --� <br /> TFIIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> **The applicant needs to contact their UDC'inspector to determine ij a permit is needed from them prior to <br /> ANY construction taking place Or any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** v _ <br /> 0 Nod 7/a be. U$4.c/ -1 * <br /> - r AiIkar1 Aa(O/ ► 7 401 ,[ . <br /> 0 D"t u 571 WI f e.� 501 5 t. 4 c_� T29 A)6✓'A P°P t1^f'�/ /Gf e, Fee Rec: lj u� <br /> mCheck#: 9(- 5' <br /> Date of staff site visit: (e/11/�)Z� Initials of site visit staff: ill— <br /> APPROVED ri <br /> BY LAND SERVICES OFFICIAL: ( _DATE: /D////ZO 2 i N c --J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF i l Wig 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 9 - ' <br /> 0 g �, „�1 <br /> Page l of 5 . C <br /> Burnett County,WI Land Use Application - Rev 12/2021 : ` .- — <br />