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Land Use Permit Application-mselby.pcc@gmail.com-Gmail 8/3/23, 12:22 PM <br /> Land Use Permit App,Icai Open with Googie Cops <br /> • I tins rLKMI I SHALL LArIKE' (ENE Y EAK r KViv! DA I E ui ISSUAINC . <br /> • ONE EXTENSION MAY BE GRANTED WITH APPROPRIATE APPLICATION. EXTE3 <br /> FOR PRIOR TO ORIGINAL PERMIT EXPIRING. <br /> • THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SU; <br /> REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR THE PURPOSE OF <br /> You (owner) are responsible for complying with state and federal laws concerning construction near or <br /> Wetlands that are not associated with open water can be difficult to identify. Failure to comply may resi <br /> construction that violates the law or other penalties or costs. For more information visit the Departmen <br /> identification web page or contact a Department of Natural Resources service center. <br /> I(owner)declare that this application(including any accompanying drawings and plans)has been ex <br /> my knowledge and belief it is true, correct and complete. I acknowledge that I am responsible fo <br /> information contained in this application (including any accompanying drawings and plans), and I <br /> that this information provided will be relied upon by Burnett County in determining whether or lit <br /> liability that may be a result of Burnett County relying on the information I am providing in this al <br /> will abide by all private/public covenants,restrictions,leases and easements which may apply to this <br /> officials charged with administrating county ordinances or other authorized persons to have access <br /> at any reasonable time for the purpose of inspection. <br /> ---ADDITIONAL COMMENTS FROM OWNER ALLOWED HERE-- <br /> OWNER'S SIGNATURE: , <. c <br /> (D� <br /> Property Owner is required to sign and date this application. <br /> SUBMIT COMPLETED APPLICATION,MAPS,PLANS AND FEE TO: <br /> BURNETT COUNTY LAND SERVICES <br /> 7410 COUNTY ROAD K,#120 <br /> SIREN,WI 54872 <br /> APPLICATIONS WILL BE ACCEPTED VIA USPS,ANY STANDARD COURIER,OR IN PERSON. I <br /> APPLICATIONS WILL BE RETURNED TO THE APPLICANT.NO EMAIL OR FAX APPLICATION' <br /> ONLY CHECK,MONEY ORDER OR CASH PAYMENT WILL BE ACCPETED. CREDIT OR DEBIT <br /> AT THIS TIME. PLEASE,MAKE CHECK PAYABLE TO: BURNETT COUNTY LAND SERVICES <br /> Please call the Land Services Department if you have questions. 715-349-2109 <br /> Burnett County,WI ordinances can be found at: <br /> Page 3 <br /> Burnett County, WI Land Use Application — Rev <br /> P;ige 4 / <br /> https://mail.google.com/mail/u/0/#inbox/FMfcgzGtwWCBdgDFSGvdLHjtHTFncRJM?projector=1&messagePartld=0.1 Page 1 of 1 <br />