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LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI c I. <br /> n <br /> Applicant Complete All Sections Below This Line 0 c N <br /> a. 1 <br /> Permit Types and Fees: (Check appropriate box) <br /> d "."---. <br /> Camping Unit(Six Months Per Year) $100 3 Year Camping unit $300 .' L <br /> •R\O <br /> """11l a <br /> ti <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. c Q <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. < 0- <br /> g" IProperty Owner's Name: (/-(A (n)-7 -7-1/1C- <br /> Property Owner's Mailing Address:?5 o?7 / C L n rl ( ww, L o.i mil $-5 3C 0 <br /> ,` City State Zip <br /> Property Site Address: t/S r fT ►4 "�`'t cz. 1.ti1 1 4 y C o <br /> Contact's Telephone Number: Lp I z--7 I (0 ( U (o 0 O a <br /> vo <br /> 11 E. <br /> Contact's Email: 'J Qe d Prot "a [( (p 4 e i/IA 5 v,. C.U v <br /> Legal Description of Property: rii <br /> r o N <br /> N <br /> CD <br /> Section#: 1 3 Town#: LI I N Range#: I & W Town of: S'tti' k S S d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CD <br /> 1. <br /> Tax ID#(1-5 digit number;found on tax statement): 3✓S? J N cm <br /> Sewer Installer: t 5 tO \I jVId d <br /> R <br /> a <br /> Camper Type: V Make: 341(Q Model: 9' fI 01 .,,,1'C Year: 2 C'C 7 c4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY F i <br /> THIS PERMIT IS SUBJECT Tot ALL CONDITIONS LISTED BELOW:CP(11,45.k" be con fiec4c(4 4L9 .5,0:1V 6/40'7 44 'II 17./li&S H , j),... <br /> - d <br /> z 0 <br /> m <br /> F Lo <br /> Fee Rec: �j <br /> ° <br /> � <br /> Date of staff site visit: )9.1 <br /> 9,I-d-d Initials of ite visit s - Check#: ,5- „; U <br /> 1 <br /> S <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 11 11 /vrn <br /> a <br /> v O 1 <br /> cn <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ? Q <br /> o. —< <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' 2 3 o <br /> zOS C; .fi- <br /> 0d <br /> r <br /> Page 1 of 3 '` <br /> Burnett County, WI Land Use Camping Application—Rev 11-2021 < g , <br /> m <br /> v L <br /> a <br /> E <br />