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• <br /> LAND USE PERMIT APPLICATION - CAMPING - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' co <br /> w <br /> d 1 <br /> Permit Types and Fees: (Check appropriate box) ,- ^p '— <br /> Camping Unit(Six Months Per Year) $100 Y V 3 Year Camping unit $300 co '\ <br /> Vs <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. p <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> ° O <br /> . <br /> Property Owner's Name: S <br /> (�[_ a <br /> Property Owner's Mailing Address: . ( f / �(— 4 , /�/� , 56 401 <br /> /1City/ St}tee Zip <br /> Property Site Address:,30�&Q Eli -6 1�(• / :��LlX tt...( p <br /> Contact's Telephone Number: /— 50 (7— 0 / 2 2 g I <br /> Contact's Email: 7' � ° .� f --; <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 7.1. EF.E• n <br /> @BurnettCountyWl.gov J v <br /> CA o r <br /> Legal Description of Property: 011 -Q 3 - // - 1 S a t, — 5 d.. c <br /> Section#: A 6 Town#: 4 / N Range#: /5 W Town of: S�-L,,,LAI/) "CI. <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> N i� - <br /> Tax ID#(1-5 digit number;found on tax statement): c 15 ?-7 a• —.W <br /> Sewer Installer: XJU 41 t—Q �,a ���kkk„ 11 d N <br /> Camper Type: 4 LL 1' Make: icG L1Vti{ik Model: ,.. 0... t_sz_cI'O Year: 0 OS- '� <br /> (.1 7c <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N V • <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v <br /> -3 <br /> - Mee.1- a�i s�e.-t-touc ks N <br /> C- avml�e.� rnu -� o e-c- ts:1 -b - 4. S4S-I , a-. alt + zs be c ' <br /> -CO, (1cl IN.-I- .ex ci re3 121/Zo23 U\ <br /> 1 I 1 <br /> x Fee Rec: �,��� <br /> Date of staff site visit: 11)23 Initials of site visit staff Check#: (p7`7� <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIA DATE: Le f'?/Zb13rn <br /> z <br /> 0 <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ri <br /> rn <br /> l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o co eL D C� <br /> z cD <br /> -< m N nii <br /> Page l of 3 rr v o - <br /> Burnett County, WI Land Use Camping Application—Rev 12-202 A - o cD <br /> � <br /> 4 <br /> 3 E u I <br /> -q a �` /J <br />