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Rmwv+l w cwineofeeer uMve6e4Eoo, v well v fillingmd gMingae revincld willtin Je shortlixuv. Rwnned <br />vbxeligarea irallxefium tge 0HWMb50M fiomlhe0HWMlandwmd Cawnlbe ]caning OR pvwwluog my <br />rdetecting,, goes <br />and <br />re,mbwur <br />Noe artom wedweight any selhments unless rptcif ,IfAly 'iilu <br />wl <br />faraway must widlWamong«quirevagereiDtlryvofpmmitisswue due. <br />Axeenryilmnure/gunge permily allow krpnvvu rnidrnelul moeage onry, Nor b6emWorhall br Luoea hedntbn. <br />• T0WNIr1OC PERMITS MAY BE RMITHED FR0M MAN MUNICIPALITIES PR0FERTY OWNER IS <br />RESPONSIBLE FOR CONTACTING THEIR TOWN FOR MORE INFORMATION. <br />• THIS PERMIT SHALL EXPIRE ONE YEAI MOM DATE OF ISSUANCE. ONE EXTENSION MAY BE GRANTED. <br />You b w er) are revpmubb: for ccopyright with Man add fc karal law, tx,,mmet mnum mr Or m und"KIs, lake, W meanie. <br />Wetlands lM are mr uraieed wiW opm weer ion be diRtWl b itlm0y. Fvlme to w ply may molt i mmoval w mWifimlm of <br />n IM1n vblmea rM teen ar other peoNlks m mnr. For mare infomwlion vuit O Ogmruoml of Nalmal Rmu wet W, <br />itl mifiemicn web pa3<mtenmua DepanmeolayNanaJ Rewrav mix terra. <br />I (owner) deelvrt that thu vppl ci tm, (Including any accompanying dnwinp antl plum) has been examined by mS and to W beat <br />of my knowledge and killed it h tme,,m mi and complete. I atknowlM¢e that[ am wp,milhl, for the dean mad veeunly atoll <br />Information mmOinetl in Nu vppli"li" (including any a,mmp,,yimg tlnwinp and plane), vnd 1 Rubber declare Nat 1 remgniee <br />that thin i rooms Clam prwAded will be relied upon by Burrell ('money In determining whether or mot to came v p,r miL I vewln all <br />kooky that may we a rewB of Barnett County rtition an the inlwmatiun 1 am Fmtlding in to, applieatimn I "knowledge, that I <br />art Ol by v11 pnvaWpublle eovenvmgo, rm ri fim. Inw and .... menu which may apply to NF Pnel. 1 agree to permit <br />u.ty a1MHh charged wiM who ndng enumly ,din m or other athumN Friends to have acm+m the rhovnm tlribed <br />prmbee at any w..ae me me Am purpre of Waterloo. <br />—ADDmONALCObDIFNISMR OWNFxALLOWFBHERE- <br />0WNE0..6SIGNATURE:� /7 f / —7 <br />(DATE) <br />pegeny Omv u rtquwi w aipr and dne Ihie aR9vaua <br />SUBMIT (NIMP ETED APTWCATION, MAPS. PLANS AND FEE TO: <br />BURNETT COUNTY LONMG <br />741000UNTYROADK0IO2 <br />SuREN, WI U872 <br />APPLICATIONS MIDI BE ACCEPTED VIA USPS. ANY STANDARD COURIER OR W PERSON. PARTIAL OR INCOMPLETE <br />APPLICATIONS WLLL BE RETURNED TO THE APPLICANT, NO EMAIL OR FAX APPLICATIONS WdL BE ACCEPTED, <br />ONLYCTECKMONEYORDERORCASBPAYFENfW BEACCPETED. CREDITORDERUCARDSARENOTACCEPIED <br />ATTIBSTLNE. PLEASBMAKECIECKPAYABLETO: nIRNFTr ,N'r'a']0NIN1 <br />Pltue cell the Lining Olficeifyou have continuum. 7I5-309-E138 <br />Burnell County, WI ordinances can In found at; M1lto'//wwwburneumunO.,,nVmdexasox?NIDMIS <br />Page 3 of 3 <br />Burnett County, WI Land Use Application — Bey WC1117 <br />