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LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI a <br /> N j <br /> Applicant Complete All Sections Below This Line = t`' <br /> a � <br /> Permit Types and Fees: (Check appropriate box) d <br /> w <br /> `SlCampingUnit(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. O <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel <br /> C <br /> o <br /> Property Owner's Name: <br /> 1 Property Owner's Mailing Address: C-T-o <br /> City State Zip <br /> Property Site Address: G0Uyytk SZ-r-"hC", Z3 f ,t�So�� tnw►�i�hi�+ WI ���C' CD <br /> Contact's Telephone Number: oz <br /> Contact's Email: C-S Mtn�.i fyn l <br /> ** If staff has a question about this application,you will be contacted via email. Make sure your email address is b N <br /> iegibie and your email provider will accept emails from the following address: @BurnettCountyWI.gov n N <br /> Legal Description of Property: S-QQ <br /> H <br /> Section#: 2 Town#:�N Range#:�W Town of: J cl GK 5 '� c <br /> 0 <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> S 4180 _j <br /> Tax ID#(1-5 digit number;found on tax statement): o It <br /> Sewer Installer: pll e <br /> L- �,yhrid <br /> Camper Type: V o Make: e' &tr Model:- Year: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o x <br /> � � ?� �tK.tvII'o� is o k -�►� `Nn,l s �(ec�,� only �' P <br /> ©P2rrn� �- ��,�ireS �Z�Zc,ol2o2s z <br /> Cam pe t- MUST- b e con net;-k_,d -t--,, +LU Seja44 C sLS� o f <br /> OYU ca►n� a4bUre.-4 pe,./ pare <br /> �"C"' lc� Fee Rec:� <br /> S x Check#: !u<!7 <br /> Date of staff site visit: Initials of site visit staff gr6l, <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> z <br /> v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> rn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? <br /> cp <br /> 0 .... 11 1111 <br /> °z cn <br /> oo IJIOJU <br /> m c <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Camping Application—Rev 11-202 <br /> v <br /> a <br /> ro <br />