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LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 1: . W�i <br /> Permit Types and Fees: (Check appropriate box) t <br /> Camping Unit(Six Months Per Year) $100 � 3 Year Camping unit $300 `' <br /> W <br /> O <br /> p —I <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. o <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> ili r <br /> 0 <br /> Property Owner's Name: E')C c �� E. <br /> Law <br /> �y,'i ,5 a <br /> Property Owner's Mailing Address: 8 d'J 1 l)t'rV ie )l-[I B/F'cCK�J �►� '/1110 5�774 <br /> `j ty 'State Zip S <br /> Property Site Address:I)/7 Li F1 .4 15te 4 , (C:).(4-IS <br /> ��� D�� h��r( s, -� <br /> Contact's Telephone Number: vim' 7l ��r O ,a , <br /> Contact's Email: WeX /4-cti e E� t.f(/V►�i I , [_0 1-11 ° E ' t <br /> 1,� r C C N cA <br /> Legal Description of Property:lcr I( i 3(t3LK�i p(cC-oC'OAI S i1 c hI le•t'S i ✓) t 11L�To cf O ck j rel o 2 <br /> � <br /> n. <br /> Section#: 1l0 Town#: LID N Range#: I W Town of: DO. CUrld p 4 <br /> *Attach additional page if needed for lengthy description OR attach a'copy of the deed OR attach tax system properly page.* `° <br /> Tax ID#(1-5 digit number;found on tax statement): 'tt i 0ch``l- 7 H-;i; <br /> o1-0i0•- 2-- 'fU —I jE- 1S-S35—DSIcoo 5•ao <br /> Sewer Installer: p P lc /) 6. <br /> Camper Type: IRV Make:T r'o ele-r" Model: I Y I1O Year: 3-0 11 (N ID <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Nz v <br /> - riktt4 a« s #lbCkc I'S F s <br /> op <br /> - CO4II, X 41) mo- C :04,8 -Fa 61a4 end 5 z <br /> (tAxksiewctle4) vati I wfi c Vin `6 -\nsia ll e d <br /> /2L Fee Rec:Date of staff site visit: /223 Initials of site visit staff l z Check#:V/.2 ik, <br /> ( <br /> APPROVED BY LAND SERVICES OFFICIAL Qyco4 � <br /> DATE: /2//2'02-3 am <br /> r <br /> a <br /> v <br /> a r IZ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF - ' I <br /> Pi fl- � n <br /> -i a CDZ riJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 41 gm o irtril <br /> to <br /> r. Co 0 <br /> j 43 S C <br /> Page l of 3 g `� w <br /> Burnett County, WI Land Use Camping Application—Rev 11-202 - . <br /> m �J <br /> 0 <br /> En <br /> 3 <br />