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LAND USE•PERMIT APPLICATION - CAMPING — Burnett County, WI a y <br /> Applicant Complete All Sections Below This Line W <br /> Permit Types and Fees: Check appropriate box n '� <br /> d � <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. C) <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> a <br /> ' O <br /> • Y / �\ <br /> Property Owner's Name• VVV <br /> Property Owner's Mailing Address: 1/ *to <br /> City State Zip <br /> Property Site Address: applied <br /> CD <br /> Contact's Telephon umber: ^ '� z t,1+ <br /> 0 <br /> Contact's Email: •u yo <br /> o N L <br /> **If staff has a question about this a plication,you will be co ted via email. Make sure your email address is 0 EL <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.go n (a <br /> Legal Description of Property: � o C <br /> Section#:A5 Town#:_ L40 N Range#: W Town of: _a <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax d <br /> P g f f S Y P PY f system property page.* m <br /> i9 <br /> Tax ID#(1-5 it nb oer;found st tement): UQ <br /> Sewer Install ' N <br /> Camper Type ak : Model: r l L Year: a000 N <br /> t <br /> AREA BELOW THIS LINE FOR LAND E VICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> 0 ►'i'I C-er ALL StTir6W d <br /> ZO C*I-PE12 It 13F CpnNNECTFP -M THE 54,UtQA►21j ay/P M gr fJLL TIMES, � Z N <br /> 0 <br /> z <br /> .o <br /> v0 <br /> J <br /> Fee Rec: 25-6.x <br /> Date of staff site visit:7/1110 2-5" Initials of site visit staff:Q x Check#:212.(0 <br /> adQreSS APp► -16o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: H/ zoz— <br /> a <br /> d <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF H CD a) M <br /> m a C C1 U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a 00 <br /> 0 v, 0 00 <br /> r� <br /> r c NC= <br /> Page 1 of 3 Ln <br /> Burnett County,WI Land Use Camping Application—Rev 11-202 <br /> d <br /> a <br />