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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 --- <br />OWNER'S SIGNATURE: <br />Property Owner is required to sign and date this application. <br />y� <br />(DATE) <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 LISPS, 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.burnetteounty.com/index.aspx?NID=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 1/2019 <br />