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s <br /> LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line °• itt <br /> Permit Types and Fees: (Check appropriate box) C7 <br /> XCamping Unit(Six Months Per Year) $100 3 Year Camping unit S300 :°-' <br /> v1 O <br /> cD <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. oF <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. ` <br /> b <br /> cip <br /> z. <br /> Property Owner's Name: C11 <br /> ;kE C 1J a I I i 11 <br /> ii S3i`� <br /> Property Owner's Mailing Address: T 7 .3 'C " , dl; N' >' _r- 11L o - <br /> � City State Zip z <br /> Property Site Address: '',,9/&IL ;I" -CLL-Ln f�C i)0/i hkiLf. r CO C o <br /> Contact's Telephone Number: is I,) -45-1-/- 9J 3 y o <br /> r A <br /> Contact's Email: OL�,L i i 0-t�5 n,o C ry) <br /> t r / J w a <br /> Legal Description of Property: I Ci i' O- t �r2 r.5 t Ci e AU rn kc i /7 a �' <br /> Section#: V w Town#: 'Y C N Range#: I L Lt.) W Town of: (_.cam k is i, d- ^p <br /> K <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): iq 5)75 <br /> o a% <br /> 5n• <br /> Sewer Installer: II)p k i i15 ��C,i,�ti . ...coLCL U�I �/i lap� oZt' <br /> Camper Type:1Lu 1 Make: (<�'t ! till mode: iS'�.;?% !'; Year: otiAVYC° <br /> ii <br /> AREA BELOW THIS LINE FOR LAND/SERVICES STAFF C I MMENTS/CONDITIONS ONLY f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -K9-0- a S.Q.,-NpQI S O o0 <br /> - �)c 2?r-c3 1 l I I )2tz 3• Mus-E- Ioe visi blk{ S-bred al. -!%s dcbe.- z N <br /> lac Conrt,Q,c- <br /> ,ki.t.Q San: S-k-rY` ad4- ct,t-L -14► - <br /> 1- 61u.e SVItd YV.e d l_uYd U,S-e ?ermt+ bvi ( t 120 1 <br /> 4 / t <br /> " Fee Rec: l d0Date of staff site visit: V/27/Zo ?�J Initials of site visit staff: S Check#: <br /> ` C" <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 5/i /2cz3 <br /> z <br /> V <br /> cn <br /> l J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a Inn] <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o CD <br /> o W r.. lV U U <br /> rt 0 0 —� rI <br /> Page l of 3 n m o <br /> Burnett County, WI Land Use Camping Application —Rev 11-2021 < 3 • <br /> 0 3 <br />