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LAND USE PERMIT APPLICATION - CAMPING— Burnett County, WI y <br /> Applicant Complete All Sections Below This Line 5. w <br /> n. i <br /> Permit Types and Fees: (Check appropriate box) p C7 <br /> Camping Unit(Six Months Per Year) $100 X 3 Year Camping unit $300 �, ...3 <br /> *NOTE:After-the-fact(when no permit is obtained prior to camping unit placement)is up to three times the normal fee. `— <br /> *Sanitary Permit MUST be approved prior to placing camping unit on parceL i <br /> o <br /> Property Owner's Name: Tindell Lake Cabin, LLC F. 1. <br /> 8337 79th Street South Cottage Grove MN 55016 0 <br /> Property Owner's Mailing Address: '. <br /> 1890 DUBOIS RD Webster, Wisconsin 54893 City State Zip <br /> Property Site Address: CD <br /> p 651-757-8235 -' E. <br /> Contact's Telephone Number: z <br /> o^ <br /> Contact's Email: JD02010@gmaIl.COm o N <br /> 0 <br /> ** If staff has a question about this application,you will be contacted via email. Make sure your email address is C <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and . • n p,a <br /> en@BurnettCountyWl.gov 4 t� <br /> PCL GOV LOT 2 (LOT 1) (TOGETHER WITH ESMT 393/264) 4 <br /> Legal Description of Property: n <br /> Section#:34 Town#: T40 N Range#: 14W W Town of: SCOTT e. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o crc N <br /> Tax ID#(1-5 digit number; found on tax statement): 18810 ..j <br /> 3' <br /> Schmitz Excavatingand Septic <br /> Sewer Installer: d <br /> 5. <br /> Camper Type:Travel Make: KYRV Model:Aspen Trail 29BH Year: 2022LA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N- o H <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> 0 IV t'e--- wJ J-s <br /> © is ca_mr.in `�.e.rM►+ arireso, I29 lzo2Lp . <br /> -�o i- <br /> z <br /> © -p ?rtye-rul Conntukd -7v -HAI Lc S`1SimCS4N.Z3Z52 z <br /> yfyiki `tsfntc, e,(ciat fa-30 odeA loost. + rectutreS a ( end I,tle P&tn;+ or <br /> 5 P(Ivy --o b.e fUrAOv l Or et rmi-H 5 t t (2029 <br /> ()or-{r� fowl do be re mcva b9 5 I I2tZpt Fee Rec:_ __O) <br /> Date of staff site visit: l l /i/Z07_3 Initials of site visit staff J N Check#: (77 <br /> tt <br /> APPROVED BY LAND SERVICES OFFICIA 4,64S DATE: I 1z9i1( <br /> y <br /> re <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF M a <br /> c-) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q - ., 4 <br /> F14 <br /> 0 o ' <br /> Pagelof3 n w <br /> Burnett County,WI Land Use Camping Application— Rev 12-202 J g ca <br /> ff <br /> 1 L.. <br />