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M)1?ITION 11, PROVISIONS <br /> • Rent,yal or etitiitit! of irccs anti acgetalitit1,a4%rill as Blain! and t•tadIII cue It.si Ilk,tcd v itlim iltr > In,-it FL-71 i(c-.tti:_trd <br /> ,h,rriine arc:t i,all at tr,tn the t)ll\�'\t Iti ll N Irani the OII11'11 lancha�ard t'ittu.tct 11w I and wt 1,e 1)rpartmtrnt h;n;t tt, <br /> tint(±ng any shorclim:trig 3n(I \ri,,et:Utc�tt.. <br /> • \;,stuictures are all+gut d a,kiihin at}a scthacl.. tllllc„ =pt ificall; prrmlllcd <br /> • Driyc\aa\ most atlect tvidllt hrit,hi 1ctloiremellts withili(10 d.ns oI hermit !late <br /> • Acres<om stntrture Sara e immit,allorr liar private residcmial•forage only. Not to he rented or used for h+nnan habLi atiun. <br /> `i'OW.N."t'DC PERMITS ltal BE RFIQUlREl) FROM 'TOWN MU I( IPAI.I'11F'". PROPER 1`Y Ow-NER is <br /> RESPONSIBLE FOR CONTAC FING 11111111 OWN FOR MORE-INFORMATION. <br /> iIII`PERMIT SHALL E\PIRE O\E: NEAR FROM I)A FF OF ISSI :1NCE'. ON I'. E.\ITNS1ON 11:11 BE(:R11\T FD, <br /> I'll IS APPLICATION <'O\S 1'Cl't'i'ES\O"I`I('E;'!'ll:1 l .11,1. 11i1'KO1'E,ME::\I;ti .11tE:tit IMF ICI FO ACCESS 1NIM)R <br /> REVIE11' BY THE: LOCAL AI 1ICP%H Y'S TA\ 1SSYSSOR FOR`T'IIF. PURPOSE:OF TA\ AksSESSME:ti i. <br /> N oil (owncr) are responsible for compli,i!! \%ith state and federal laNs concerning ion l'UCUUn bear ,r irn wetlands. lakes, and ti(fl'itt}ik. <br /> 1t etlands that are not associated v%iih ,lien +voter can he difficult to identify. Failure to cunili1v may result in removal or modification of <br /> amstruction that violates the lair or other penalties or costs. For store. information %kit the Department of Natural Resources i.vetland" <br /> identification"eh page or contact a Deportment ol'Natural Resources service center. <br /> 1(owner)declare that this application(Unclutiing'an', aecompaming drawings anti plans)has been eyanained by me,and to the hest of <br /> my knowledge and belief it is true, correct .and complete. 1 acknowledge that I am responsible for the detail and :accuracy of all <br /> information contained in this application(including any accompanying drawings and plans). and 1 further declare that I recognise <br /> that this information provided will be relied upon fly Burnett County in determining whether or not to issue a permit. I accept all <br /> liability that may be a result of Burnett(bounty relying on the information i ant providing in this application. t acknowledge that I <br /> will abide by all privatelpublic covenants, restrictions,leases and casements which may apply to this parcel. I agree to permit counh <br /> officials charged with administrating county ordinances or other authorized persons to have access to the above-described premises <br /> it any reasonable time for the purpose of inspection. <br /> ---ADD1I ZONAL('t NIMENfS FROM OWNER Al LOWED 111•10 --- <br /> Ot��NEK5 SIGNATURE: <br /> (DATE:) <br /> rrof rty tha tie r N required it)sign and date this applicatitS <br /> `L13\t!1 CO\1PLFTED.�PPl,ICA'1'tO\, MAPS. PLANS .-AND FEE TO: <br /> BURNI,FF COL \TY LAND SER\'IC'I'.S <br /> 7410 COUNTY ROAD K.n 120 <br /> SIREN,WI 54872 <br /> APPLiCATIONS WILL BE ACCEPTED VIA USPS,ANY STANDARD COURIER,OR 1N Pt.RSON. PARTIAL OR INCOMPH I E <br /> APPLICATiONS WILL.BE RETURNED TO THE APPLICANT..NO EMAIL OR FAX APPL.ICA HONS WILL Ill:AC C'EP 1T.D. <br /> ONLY CHECK.MONEY ORDt R OR CASH PAYh4FNI Wit.l.BE ACCM:I 1{1), C'RI'Dfl OR DF.H11 C ARDS ARF No AC'C'E;P"I`IJ <br /> 1I it IIS TIME. PLEASE':, MAKE C'i IFCK PAYABLI"T'O: BLlRNE11 (QLT•�fY l.,\11)SI,RVICE_` <br /> Please call the Land Service Department if you have questions. 715-349-2109 <br /> Burnett County,W1 ordinances can be found at: httn•/h3wvNv burnettet)unty.corn/index.ast)x?Nil)=11)43 <br /> Page 3 of 4 <br /> Burnett E'Ounty, NVI Lund Use Application — Rev 1/2019 <br />