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* pjcaSe ems ( a cow 4 <br /> LAND USE PERMIT APPLICATION —Burnett County, WI b <br /> c ''• 2 <br /> Applicant Com lete All Sections Below This Line a <br /> Permit Types and FeesfPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 1 IWI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 1 lBoathouse $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. <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r~ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Q <br /> z <br /> a <br /> Property Owner's Name- ,John wolf <br /> Property Owner's Mailing Address: 5008 W Dante Ave,Tampa,FL 33629 _ <br /> City State Zip K " <br /> Property Site Address: 3772 Mallard Lake Road .. <br /> a G <br /> Contact's Telephone Number:_, ep 13 • *5 To <br /> 0 <br /> Contact's Email: J W Lr- Q VO t f&"V Pt ALL <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov <br /> Legal Description of Property: LOT 4 CSM#3109 V 14 P 155(GOV LOT 6)#287164 d <br /> — ---- <br /> CT <br /> Section#: S36 Town#: T40 N Range#: R15W W Town of. Jackson <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): 6123 W- V4 <br /> Proposed Use of Structure/Addition: Boathouse f- 4 a+rk44104_E <br /> Anticipated Start Date:- Home/Cabin;Commercial Business;Bedroom;Deck:etc.) n1 <br /> Building Contractor: Sewer Installer.. " Pb t in� v' <br /> O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ON[A z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LIS'l,'-FB-R L 011 ': d x <br /> to <br /> b1° uS 2d Sruyj v''i�7 <br /> �ro�low ail r�S-�t(Jhl7??S 1 000u e Fee r�� <br /> ° Check#: 113yly <br /> s .�v -C1Ct erd 2 �eo�rs S f�N 25-131 <br /> C�D � M a <br /> Date of staff site visit:7'1 S 12,0Z5 Initials of site visit staff�(�__ <br /> /,�/ <br /> o. <br /> c_ <br /> APPROVED BV LAND SERVICES OFFICIAE % `"'t DATE:7l� `7 cn ao C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N0. [N <br /> 00 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �_ C <br /> !T <br /> Page 1 of 5 � <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />