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n <br /> LAND USE PERMIT APPLICATION - CAMPING- Burnett County, WI a N <br /> Applicant Complete All Sections Below This Line ° N <br /> n. , <br /> Permit Types and Fees: (Check appropriate box) d <br /> • Camping Unit(Six Months Per Year) $100 3 Year Camping unit $300 CD' <br /> NOO <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. o �\ <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> o { <br /> 4 r�/Y 1.U.1/ V "`�'! L 5503 a <br /> Property Owner's Name: 1J -el �eir w^ <br /> �a`r rnu'f ,�d/_� M 4 3 <br /> Property Owner's Mailing Address: •/��'V IIc „(� g <br /> b Z (r <br /> 't State Zip S <br /> z <br /> Property Site Address: �'�ay 1 (re 'Got $'/$ )/ 0 , °x, 'I, <br /> Contact's Telephone Number: <br /> {, A.D.7-o 3 O �. .C -10 <br /> -21 <br /> ,r�`,� w n <br /> Contact's Email: 1 VY 1 Qj 61 141 .G to . <br /> Legal Description of Property: a GSA 5065 Vol .Zb S? o n L, <br /> Section#: 13 Town#: 1 I N Range#: 1 LI W Town of: vS W 1c-4 ' d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r <br /> Tax ID#(1-5 digit number; found on tax statement): 7"; &- -- N°• a� <br /> Sewer Installer:{� 16110414 <br /> 61104 l 0 <br /> Camper Type: Make: X./4N Model: Lamle Year: G v) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> a <br /> till thee-- kill S�b4 s ( r r - ,i -pc(J,5 c),)gin,t- 19ecome -1.0- 4 sofe 4,f-m,, 514,-,/e/11 4,f-4 1/ +, z <br /> �/L)ain <br /> �Z., y Fee Rec: <br /> Date of staff site visit:5/1 v( of s to visit of :i-g- <br /> Initials = Check#: /0C.�1 <br /> cn <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: 5/?3/a2_ m <br /> /7 z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . 0' <br /> Em <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT (12 , <br /> v` c' < <br /> NJ <br /> Page l of 3 <br /> Burnett County,WI Land Use Camping Application—Rev 11-2021 < (L )...) <br /> G <br /> a <br /> i <br /> �o <br />