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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 09 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CIO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 KJ <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 1 <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ' <br /> o <br /> Property Owner's Name:_HHM LLC_Mark I Ieverly o <br /> 0 <br /> c <br /> Property Owner's Mailing Address:_2288 Segundo Ct#1 Pleasanton CA. 94588 <br /> City State Zip 5 <br /> Property Site Address: Lots 13,14,15 and 16 between Co.RD A&2823 Co Rd A Webster 54893 0 <br /> Contact's Telephone Number:_925-683-1418 _"L e <br /> d <br /> Contact's Email:_mark,heverly@outlook.com <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov a �° <br /> Legal Description of Property: Oak Lake addition I Lots 13,14.15 and 16 ti <br /> Section#: 0 Town#: _N Range#: W Town of:_Scott <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* � <br /> N � <br /> Tax ID#(1-5 digit number;found on tax statement):_19142 p <br /> C <br /> Proposed Use of Structure/Addition: Add a 12'x 20' shed y <br /> Anticipated Start Date:—May 5 (Home,(abiti;Commercial Business;Be&-oom;Deck;etc.) rn <br /> Building Contractor:_American Steel Sewer Installer: O _ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> IQ MEET A-LL 5CT`&gC_JCS c <br /> �IJOT 7a YE UsCD FOR tWrn� tfA8tr�7toN, <br /> H F�V <br /> 3O A.PPLV pop-, AO O SS $y (�/t(zo25. Fee Rec: 15z!> — <br /> Check#: W-3—7 <br /> �e <br /> Date of staff site visit: q12/ 25 i 511825 Initials of site visit staff:P6 <br /> l DATE 1Z25 4 <br /> APPROVED BY LAND SERVICES OFFICIAL: • 5 I er, <br /> UPON APPROVAL: APPLI NT UST POST COPY OF I h <br /> �� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 � �� <br />