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LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI a n <br /> Applicant Complete All Sections Below This Line a c a N <br /> a1 <br /> Permit Types and Fees: (Check appropriate box) Cd7 Camping Unit(Six Months Per Year) $100 3 Year Camping unit $300 `�° 0 <br /> �, O <br /> F <br /> a <br /> a <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 /> r $ <br /> o ` , <br /> cn <br /> co <br /> Property Owner's Name: CkR i')n 4 5 a.--\N Bc.A,c, <br /> 4 <br /> Property Owner's Mailing Address: k IN ( 'L C , * %' - — Q_- . V) 51.11 A g <br /> Ili <br /> / City State Zip i- <br /> Property Site Address: 2,'135t..3 c),. ,\Nr,t )eUG <br /> �C' <br /> c, OOCN1C`)V:)‘XCC) W t "n - <br /> Contact's Telephone Number: (c.kZ.- 36?) Lki 0 O <br /> '41 <br /> Contact's Email: (c-,v.,_\7 cc\%C 01 C Cts C C 1 CC.`� l'TZCX t Ces 01\� p ° <br /> Legal Description of Property: N\,.,/ '1`\ �J ,/`1ril <br /> Section#: 2.1 Town#:--3,01N N Range#: \\ W Town of:\AIL,k (\o,rS'\p,h \ d r <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a <br /> CN <br /> Tax ID#(1-5 digit number; found on tax statement): : 5 Ly <br /> N 00 <br /> Sewer Installer: �C' J, `V, d <br /> � <br /> Camper Type: ,_\ / (0 Make: 2.0Model: \c <br /> Ca c \Q. Year: vl <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t V <br /> 53 <br /> THIS PERMIT IS SUBJECT TO ALL CO DITIONS LISTED BELOW: d <br /> Ca/el- rn,As- - reed- (111 5 ac/6 <br /> cio <br /> c 4 St c, a all �'/ne5 Cn <br /> • <br /> cc m per �e eta <br /> Porgy i)ey rL.L$ - � a/AmLJd a-C.r Co/15-6A4ckeil 6 Boll e k z <br /> Fee Rec: O `- <br /> Date of staff site visit:6/261x') Initials of site v' it staff: 41' S Check#: (� <br /> // /, E <br /> APPROVED BY LAND SERVICES OFFICIAL: $ . .= , ,�� DATE: 5/26612. <br /> // a <br /> z <br /> o n <br /> APPLICANT MUST POST COPY OF <br /> Iiiiii <br /> rnz.,z, <br /> UPON APPROVAL: A C � �.� j � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 0 0 o 0 <br /> Page 1 of 3 n <br /> 3 U�U <br /> Burnett County, WI Land Use Camping Application-Rev 11-2021 < �L J <br /> m <br /> O <br /> cn <br /> a <br />