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LAND USE PERMIT APPLICATION - CAMPING- Burnett County, WI a 2 n <br /> Applicant Complete All Sections Below This Line 0' ra N <br /> a 1 <br /> Permit Types and Fees: (Check appropriate box) C7 <br /> Camping Unit(Six Months Per Year) $100 3 Year Camping unit $300 <br /> O <br /> D <br /> Ei <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. 5). vN <br /> o <br /> N CA 3 <br /> Property Owner's Name: $ , , ill, ' 1 .(/1 w Iv <br /> Property Owner's Mailing Address: 5 5 ( 1 11 10 a- -1 a CLC--b (17414, S CU 00 1 a <br /> - f City State Zip <br /> Property Site Address: 3 ,0 v12 O E( ((I ( , 'y 1,D 6r-L 1 ,DGic i t_til a U.� l O o <br /> Contact's Telephone Number: jO ii - ' ) --l g ? J O -c <br /> n "73::'Contact's Email: <br /> CV <br /> Legal Description of Property: 6 11 •-03A- '41 - 1S - g - 5 0,S C 0 Eli <br /> a <br /> Section#: Town#: LI I N Range#: 15 W Town of: ,5 (j 'r( ,,,Ly�i d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): .+1416 C, b A (-1 k 0 1 D ,SN *0 <br /> 9 Lff W <br /> Sewer Installer: Aj � a � d _c <br /> S. <br /> Camper Type: LAP'42.:Jc.)) Make: Model: Year: d© 0$ cA <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 /> 1/16e,- 411 564-b.JA-5 <br /> a eject +0, <br /> o�'I'�(f� V z v1 <br /> 1 <br /> LA <br /> // ,[ // Fee Rec:1 Tt <br /> Date of staff site visit:rb��5/�? Initials site vis't st J-11, = Check#:j 1(O6/ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:6(/740? a <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a- ' <br /> `= Z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT @ S o <br /> D o '�' D <br /> Or C NOm <br /> Page 1 of 3 . 3' po <br /> Burnett County, WI Land Use Camping Application—Rev 11-2021 = _ <br /> LL <br /> a <br />