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LAND USE PERMIT APPLICATION - CAMPING — Burnett County, WI a n <br /> , y <br /> Applicant Complete All Sections Below This Line 0 <br /> a. , <br /> Permit Types and Fees: (Check appropriate box T:Y_ <br /> Camping Unit(Six Months Per Year) $100 X 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. p <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel r <br /> a <br /> n <br /> 0 <br /> Property Owner's Name: Ty R Slonneger g <br /> Property Owner's Mailing Address: 28558 Irish Lane Washington, IL, 61571F. <br /> City State Zip n t <br /> Property Site Address: 28365 Kilkare Rd. - Pb <br /> Contact's Telephone Number: 309-635-6294 z <br /> 411 <br /> Contact's Email: Ty@mselectricinc.com R o l N <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is $ ' <br /> legible and your email provider will accept emails from the following address: BurnettCountyWI.gov z F. n <br /> LOT 2 CSM 5195 VOL 29 P 239 RECORDED AS c <br /> Legal Description of Property: DOCUMENT 477928 (GOV LOT 1) u) c C <br /> I. <br /> Section#: S23 Town#: T40 N Range#: R15 W Town of: Jackson CD <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* -D d <br /> n <br /> Tax ID#(1-5 digit number;found on tax statement): 36287 0 rra N <br /> Wade Rufsholm g. N .� <br /> Sewer Installer: u, ----- <br /> q W <br /> Camper Type: Travel Trailer Make:Keystone Model: Bullet Year: 2013 —Dtv <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: cNI <br /> F w <br /> x <br /> D is purmi1 r f6 oft 4 11212021 y <br /> H <br /> z <br /> "§ <br /> u 1f II V lL Fee Rec: L <br /> Date of staff site visit: 0�1 O_{G/7, 1 Initials of site visit staff: �lr Check#:�`� G'C' <br /> �y <br /> APPROVED BY LAND SERVICES OFFICIAL. J'/- (J <br /> 9 DATE: 1 1Z 2 q ro <br /> d <br /> E <br /> c. <br /> rri <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF AErni <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a E 0 <br /> C . ^' Ind <br /> o .g � <br /> N <br /> r' O O tV O <br /> (D S (� <br /> Page l of 3 E� °, r <br /> Burnett County, WI Land Use Camping Application—Rev 12-2023 ri s <br /> d <br />