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LAND USE PERMIT APPLICATION - CAMPING — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line °o N <br /> a. to <br /> Permit Types and Fees: (Check appropriate bop C7 <br /> Camping Unit(Six Months Per Year) $100 >( 3 Year Camping unit $300 <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. i O <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> ar <br /> Property Owner's Name: Q C' ' /N-/ ��----)/1 C /rc 61 PG f E • <br /> Property Owner's Mailing Address: (.e/ SS /l L/ _. l' Lci r< cckCry �L��� K h <br /> P <br /> City State Zips <br /> Property Site Address: , /'7 C7 t r, I L.4•C (Leg'Ss 124( e fe" C, i.t.'i .59 3 ) <br /> a <br /> Contact's Telephone Number: f''/Z • p l _ 3US 9/4/7 j 5c- 3 c7p3 z <br /> / o <br /> O n r- . . <br /> Contact's Email: t0�2 /1- .SA e/k c��''. C.�/�= YA.7. A C)7: C.�)� m ° \ <br /> o <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is O9 d <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and n 5. c4 • k <br /> @BurnettCountyWI.gov Cx, <br /> 1 T CA o �N <br /> Legal Description of Property:SeC IL r A)3 ) e�./sr ( CS n-1 0 a3 p y 0 i e/ ,,o& , p a NI <br /> Section#: 1/). Town#: 3 7 N Range#: I S W Town of: fir ci 1 d LA4e , JV 'e <br /> eD <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> N .v <br /> Tax ID#(1-5 digit number;found on tax statement): 3 i/y 7 ° o° W <br /> ova <br /> Sewer Installer: /Z05-5 /Inc/�'" �j c,P4I e . v <br /> R. <br /> Camper Type: A, k r''v 2 k t/'Make: ieg < Model: ct.,"r5` /2 r t ' • Year: : U; <br /> ,i1/ - <br /> PP v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Es .- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> 0 l''1et all 5*ba.ek / - <br /> 3 :...\ v <br /> -�'�t.( ca.M CAA hO be Jsed� -f l d''t` " 3° �' J .,C.. <br /> it-14 <br /> p <br /> S ;A a (alert IYar ir�-s z is <br /> gy4,44.... be- certnec 54401 <br /> °9 <br /> -, Fee Rec: 300"2 <br /> x <br /> / I <br /> Date of staff site visit:511712'3j 6/131a-3 Initials of site visit aff: N Check#: `7.2(01 <br /> e <br /> m <br /> Elli12-3 z <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF n r- inni <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <= z <br /> con <br /> Page 1 of 3 m i=_ c <br /> Burnett County,WI Land Use Camping Application-Rev 12-202 J < a ` w triiii <br /> m m <br /> O <br /> cn <br /> a JJ <br /> - <br /> -o <br />