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LAND USE PERMIT APPLICATION - CAMPING--Burnett;Count. WI a '° n <br /> tr • ; { I. r g <br /> . .•!A iicant Comple'orAmsectio Belminiimiiii75 f i N <br /> r Permit Types and Fees: (Check appropriate box . I I d <br /> Camping Unit(Six Months Per Year) $100• . _.3 Year Camping unit `i 1 $300 <br /> 0 <br /> *KITE:After-the-fact when no itis obtained prior to cam in unit lacement)is u to three times the normal fee. o <br /> r*Sanitary Permit ML _UST b-approved prior to placing camping unit on parcel. I P N <br /> • <br /> F. <br /> \ � i- <br /> Property Owner's Name:______ ____..v_ ' �`�� <br /> Property Owner's Mailing Address: '7 C . .v‘ ‘.. it.- - 01 I'SSatkS `9 <br /> City State Zip . FT • <br /> Property Site Address: 2,-2-42A C �cc&-�k•c�C W1 o' • <br /> • 0 . � ,� <br /> Contact's Telephone Number: • \S2- A\2'• U206 4 i I <br /> Contact's Email: $'r '\)\'* �.eAD , c t^ <br /> 0 c <br /> Legal Description of Property: - \T 5 G <br /> Section#: Town#: N Range#: W Town of d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .0 <br /> ON <br /> ,,,,, <br /> Tax ID#(1-5 digit number;found on tax statement): 4 1 t7 l l v '�' <br /> A e. <br /> v,4Sewer Installer: NA F • ) <br /> Camper Type: 17,cc Make: — Mode!: . Year: tn <br /> NRE-A REEOWAHISWINE4FOR)LrANDTSERVICESISTAFFiCOMAENTSLGONDITIONSi0NIN ! <br /> THIS-PERMIT'IS SUBJECT TO ALL CONDITIONS:LISTED_BELOW: <br /> (14 eel- a L( 510 P <br /> pb501,41cy . noiz z , <br /> _kite, c t/1 1 -fr der <br /> ! I i , <br /> Fee Rec: (r- ,^L,±:' <br /> Date of staff site visit: "1 / ` Initials o site rtl.'t .t: u C i = Check#: 1 ---(_Z-2 <br /> . i //j x <br /> APPROVED BY LAND SERVICES OFFICIAL: .i._ , 4DATE: 6/61)102. 1. <br /> P , 41 - '� <br /> � <br /> 1,.L..!RC+�!N ABIW®AVAL: AP I`CANT 115 WSW €0�� o r} a <br /> m tow 2> It: <br /> ' �IeNIE�B BE, 4:" ,,0 ABBLI,CATL N INP AIN'. :AO:: + 1 ! H N Cts <br /> y CO <br /> K v ap <br /> Page 1 of 3 '° 3.< N <br /> Burnett County,WI Land Use Camping Application•-Rev 11-2021 < = Ill ] <br /> • L " iJ <br /> X <br />