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LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line E. <br /> N <br /> te <br /> Permit Types and Fees: (Check appropriate box G <br /> XCamping Unit(Six Months Per Year) I $100 3 Year Camping unit $300 o O <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. r ,L.----- <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> o <br /> Property Owner's Name: Joe, 4- ?),:::\ctacci- � ��J l o <br /> Property Owner's Mailing Address: \-` 1&---5 T`SA SA t\ e..- ria3`�--Tu 11S MN Jsossi <br /> Q \et\IOC ; l'5(Q R ti,,i' d o/ Cl O r"� City State Zip <br /> Property Site Address: 1 <br /> Contact's Telephone Number: P7 tO13— StDO—075 s' z �� <br /> Contact's Email: ��5 q60O @ \.c \OO C()tA C g <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is '4 ' <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and n =. @ W <br /> @BurnettCountyWl.gov to <br /> Legal Description of Property: i -C" ?k; ?Gt>&� } I 0 Clte \1 CCL%\1 . 1-0 i a r- 0.,Section#: 1 1 Town#:40 N Range#: j 5 W Town of: JaC[`, cl 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): I 2.� e <br /> el <br /> Sewer Installer: T\0 \iN5 S c j- & '- 0 C'<AV kt,,\ d <br /> �t`c:W e\. \ 2 <br /> Camper Type: ¶c`cx:\\er Make: NVuC\€. Model: 'is`‘ jC1�cL\e Year: 0\ <br /> rn <br /> 40 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C .— c - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: g d <br /> 10•jie- Ai sect <br /> 0 rt -- be cemeesici 71D fir,,{z,✓ V54e1 <br /> 44 4 c,ll t. --"Qe <br /> z N <br /> , 3 <br /> / �l Fee Rec:'iC'�:3 <br /> Date of staff site visit: <br /> l(pl?3 Initials o site visit aff: J. Check#: (/77 <br /> 8 <br /> tz <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /18/23 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t 0 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT `s <br /> 2� <br /> 4-7 <br /> .t <br /> i N 4, <br /> Page 1 of 3 gift <br /> Burnett County,WI Land Use Camping Application—Rev 12-2022 : <br /> 1 <br />