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• <br /> y !n <br /> Applicant Complete All Sections Below This Line 5' N <br /> c. W <br /> Permit Types and Fees: (Check appropriate bop C7 <br /> jC Camping Unit(Six Months Per Year) I $100 3 Year Camping unit I $300 c <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 /> 0 Illbc <br /> Property Owner's Name: . &J , ( A aSa,11‘(ti ,' 0--A`lee `<cv 1 9. � <br /> Cc a- <br /> Property Owner's Mailing Address: 10 11 ��,ae'aV\AOI -Q. C-.SC-dt- M 55 3 1 .. <br /> City State Zip <br /> Property Site Address:2( /O n`< v a �.0 Lit\ `sivz.:.,tviz - <br /> Contact's Telephone Number: "52' L'C> t O O 0 , , <br /> 9 <br /> ` O ••n — <br /> Contact's Email: Se -u"\1 ‹-1v� ZK`cN.�n cu ��'� <br /> `` Y\a..�l 1 c.o, xi o <br /> **If staff has a question about this application,you will bebintacted via email. Make sure your email address is P b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and - cn <br /> @BurnettCountyWI.gov tlll` <br /> I`. <br /> Legal Description of Property: r �r11 Vr2O 17(� ( 369 (o�� ) o CD r <br /> Section#: 3 Town#: 3 N Range#: ILA. W Town of: ( ki) d <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach taxsystem property `� <br /> P S .f f S Y P P P h' <br /> N 'U <br /> Tax ID#(1-5 digit number;found on tax statement): c 17 <br /> 5' <br /> Sewer Installer: S1l\1Q.,(` 11() 0. <br /> Camper TypeRol. 1Q+k.✓1 A Make:jz k Model: Pa tt 0± Year: .2o LO ID <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C o x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: —W i x <br /> eel/Q nL cecf , 15 , Wad11eedS (and v5e 44* -C2'r rb <br /> Slos tt by- 0 lllc? 3 . <br /> 010164 Otit SAO 4 e...... <br /> � k <br /> re! +P be Cain ec 544:c y a� a(l -f,i <br /> 0 <br /> Ploakio A oitu 1z , rvic- b 91023 <br /> u Fee Rec: l v(�� <br /> Date of staff site visit: u//�2-3 Initial of site ' it staff: 11 1� Check#: 30s7 <br /> // tlf <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 DATE: i/? h-3 -� J <br /> to r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF F E t 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0, 0 N ,- <br /> Page l of 3 r) w tru <br /> Burnett County,WI Land Use Camping Application—Rev 12-2022 <br />