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LAND USE PERMIT APPLICATION - CAMPING — Burnett County, WI <br /> N <br /> Applicant Complete All Sections Below This Line a. w <br /> n. <br /> Permit Types and Fees: (Check appropriate box) 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. p <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parcel. <br /> rD <br /> o -� <br /> Property Owner's Name: ��a� �' 1� '<llz rlS cv1 • <br /> Property Owner's Mailing Address: 202. V `C.0._ EA < IZt'f ey ir1 S J30R. <br /> City State Zip <br /> Property Site Address: /N k Ccal-- L. e <br /> r g- <br /> 3. <br /> Contact's Telephone Number: �te 3 " 2-2-A — �f 39 1 R. z <br /> z <br /> \ ' <br /> Contact's Email: �U`lam' �� �� �n � �1Q-�-icy. ocr• z o N !N., <br /> ** If staff has a question about this application, you will be contacted via email. Make sure your email address is o r� <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and n a• n (� <br /> @BurnettCountyWLgov <br /> r» 3 <br /> 72 <br /> Legal Description of Property:Sex- 2 Z SK v IS 2qs3 (1*3�(32./ 0ro <br /> Section#: 2Ci Town#: 46 N Range#: W Town of: S Cott ov d <br /> ni <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* G-• <br /> N ro <br /> Tax ID#(1-5 digit number; found on tax statement): S. \ ?. <br /> Sewer Installer: <br /> ns P. N� <br /> 1, N <br /> Camper Type: b kA.%�'�.N-c-1 Make: kN.� Sk-O+Ie- Model: Lax C-C1c' Year: o %pS <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ! ! H H <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a 6y _ <br /> —Nvi,4 a ,e,�loc -S o ":". <br /> nYl�c.- d �'o 'I' Saf i 4torGf W&-kIn of au +164-�. z- cot kr ,kb \ix <br /> D- 14Lt ant coy*' o -d cief Ple. <br /> � <br /> Date of staff site visit: /'Y JZ 1 Ini ials of site i it staff: _ Fee Rec: !?� <br /> 7 Check#: y',3 9 <br /> 6 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:1 I 1 ZOn o <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF n �,� m (( <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 2 5.a w <br /> 0 <br /> rZ- v o t <br /> "0 7 o t <br /> Pagelof3 0 w <br /> Burnett County, WI Land Use Camping Application—Rev 12-2022 < S <br /> t <br /> d <br /> a <br />