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LAND USE PERMIT APPLICATION - CAMPING—Burnett County, WI y <br /> Applicant Complete All Sections Below This Line o <br /> o. ;---0 <br /> Permit Types and Fees:(Check appropriate box) = d <br /> d <br /> Camping Unit(Six Months Per Year) $100 3 Year Camping unit $300 `%C <br /> X _ l C <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. o (-3*Sanitary Permit MUST be approved prior to placing camping unit on parcel 0 <br /> Property Owner's Name: E 112 �� <br /> ``1flfl S o'P r / a- c. <br /> Property Owner's Mailing Address: 1 V" 3 Ycl. S Jr , E, N e w I ��[e U V shoo 1 Iv r <br /> ��� City State Zip o <br /> Property Site Address: .,y o <br /> o 0 J ' r <br /> 75 Contact's Telephone Number. 951),"2- ' c 1 L1 Li o <br /> L& Shoe 020g 0 Va.a) I , L w 1 m.11 E li <br /> Contact's Email: m <br /> Legal Description of Property: W i' 2 C5)`•'\ V 2 i 9f l (#3.1( 1323) C NE 5E. d-_ n o <br /> �P 3 Rangelp Mee hb�l NWs ) a <br /> Section#: Z Town#:'T l N #: W Town of: d <br /> w <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 dipi� �m r_fotj 'o statement): © 1 o o <br /> ww '' /% 5 <br /> act <br /> Sewer Installer: VP' S W r Ja s a wV'e -tyro' 5 no d <br /> rn tV 'tt' all - 0of cam-' <br /> Camper Type: Make: Model: Year: <br /> .pCf' <br /> AREA BELOW IS LINE FOR LAND SERVI CES COM3MIENI(NTS/CONDITIONS ONLY f , <br /> TH <br /> THIS PERMIT IS SUB CT TO ALL CONDITIONS LISTED BELOW: y o d <br /> e Pee-- 41/ 54, <br /> CA/7 -1 � t Pi bl� z 8 <br /> Ofteliligit_ -6 e_ me rl d27 Meel 75 x <br /> Psi✓ m be 444,A14, <br /> L 'I / U Fee Rec: <br /> Date of staff site visit:512-4 I 2'6j 5//1°(23 Initials site staff: 'I y C�#: 10 f 0 <br /> . . f. , <br /> U' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:S/��/� <br /> m <br /> r <br /> a <br /> rn <br /> cn <br /> o 0 ,��.1JJ <br /> rn <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m g co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o $5 ro ER <br /> r.r yA tr <br /> m c <br /> Pagelof3 by v Q <br /> Burnett County,WI Land Use Camping Application—Rev 11-2021 0 g noIN <br /> g <br /> L�J <br />