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LAND USE PERMIT APPLICATION - CAMPING— Burnett Caunty, WI a <br /> Applicant Complete All Sections Below This Line k4 <br /> Permit T es and Fees: Check a ro riate box p <br /> am in Unit Six Months Per Year (S—IF03 kjzl 3 Year Camping unit <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> 0 <br /> ]j o Property Owner's Name: Q>�^ ����, �el, 41�- <br /> bef <br /> Property Owner's Mailing Address: �(7 ( > Z. <br /> City State Zip <br /> Property Site Address:. 6-�-7 2- s c, i ow.) L c-J 4e,,- uc, ( CD <br /> Contact's Telephone Number: j Z_J(� G' z <br /> o <br /> Contact's Email:5c-�E ,,pt,( `L S J t1 1- C b ' v, <br /> ** If staffhas a question about this application,you will be contacted via email. Make sure your email address is b iv <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property: )✓t�l �I C �:y\ -�7k;t G () l✓}'r ?�Ir c-( (��t] / m c y <br /> Section#: Town#: _N Range#: W Town of: Jn� a <br /> *Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax stem property page.* 0 S <br /> Tax ID#(1-5 digit number;found on tax statement): �( � o a. <br /> 1 0 <br /> Sewer Installer: t� <br /> Camper Type: rl .t?✓ Make: C Model: �T` , �r Year: •r? O �D <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o 0 <br /> GcLm?e r -b be, C0nhtL,+-f-d +10 4t�-' ��nt+Odj Sy&,k-M C.f 4V <br /> v <br /> z <br /> z <br /> �n Fee Rec: <br /> Date of staff site visit: �1117 <br /> &Z5 Initials of site visit staff:-G Check#: ;L2 <br /> APPROVED BV LAND SERVICES OFFICIALC� Ztj <br /> DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Q <br /> CW <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT `� ` <br /> Y � � N <br /> m r. <br /> xr r: <br /> Page 1 of 3 � (� <br /> Burnett County,WI Land Use Camping Application—Rev 11-202 r� <br /> 0 <br /> ro <br />