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• <br /> . 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal or cutting of trees and vegetation is restricted within the shoreline area. Restricted shoreline area is all area from the <br /> OHWM to 50 ft from the OHWM. Contact the Land Services Department prior to cutting any shoreline trees and vegetation. <br /> • No structures(including retaining walls,etc.)are allowed within any setback,unless specifically permitted. <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted. <br /> • Driveway must meet width/height requirements within 60 days of permit issuance date. <br /> **TOWN/UDC PERMITS MAY BE REQUIRED. OWNER IS RESPONSIBLE FOR CONTACTING THE TOWN FOR MORE <br /> INFORMATION. <br /> **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> You (owner) are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. <br /> Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of <br /> construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources wetlands <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 examined by me and to the best of <br /> my knowledge and belief it is true, correct and complete. I 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 I further declare that I recognize <br /> that this information provided will be relied upon by Burnett County in determining whether to issue a permit. I further accept all <br /> liability that may be a result of Burnett County relying on the information I am providing in this application. I acknowledge that I <br /> will abide by all private/public covenants,restrictions,leases and easements which may apply to this parcel. I agree to permit county <br /> officials charged with administrating county ordinances or other authorized persons to have access to the above-described premises <br /> at any reasonable time for the purpose of inspection. <br /> ---ADDITIONAL COMMENTS FROM OWNER ALLOWED HERE--- /a ; r1 470'f 3q <br /> ii_it <br /> iri <br /> OWNER'S SIGNATURE: -4 <br /> -� ;. (�L�\t,e / C/".. — <br /> (DATE) <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. PARTIAL OR INCOMPLETE <br /> APPLICATIONS WILL BE RETURNED TO THE APPLICANT. <br /> NO EMAIL OR FAX APPLICATIONS WILL BE ACCEPTED. <br /> ONLY CHECK,MONEY ORDER OR CASH PAYMENT WILL BE ACCPETED. CREDIT OR DEBIT CARDS ARE NOT ACCEPTED <br /> AT THIS TIME. 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: http://www.burnettcounty.com/index.aspx?N1D=1043 <br /> See Burnett County Ordinance for definition of on-premise, off-premise and directional signs. <br /> Page 3 of 3 <br /> Burnett County, WI Sign Application—Rev 12/2021 <br />