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ADDITIONAL PROVISIONS <br />`Tom Pek/50v\ <br />4"- <br />pUkt'k <br />• Removal or cutting of trees and vegetation, as well as filling and grading are restricted within the shoreline area. Restricted <br />shoreline area is all area from the OHWM to 50 ft from the OHWM landward. Contact the Land Services Department prior to <br />cutting any shoreline trees and vegetation. vlla , <br />• No structures are allowed within any setback, unless specifically permitted. Ck �`O d\ <br />• Driveway must meet width/height requirements within 60 days of permit issuance date. -Q i\ <br />• Accessory structure/garage permits allow for private residential storage only. Not to be rented or used for human habitation. <br />• TOWN/UDC PERMITS MAY BE REQUIRED FROM TOWN MUNICIPALITIES. PROPERTY OWNER IS <br />RESPONSIBLE FOR CONTACTING THEIR TOWN FOR MORE INFORMATION. <br />• THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE. ONE EXTENSION MAY BE GRANTED. <br />• THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SUBJECT TO ACCESS AND/OR <br />REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR THE PURPOSE OF TAX ASSESSMENT. <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 or not to issue a permit. I 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 -- <br />OWNER'S SIGNATURE: ► V (4 liq <br />(DA ) <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. 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. 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: http://www.burnettcounty.com/index.asDx?NID=1043 <br />Page 3 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2019 <br />