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LST c y '—/ion /4 Z. //A' . /7/Gti,/ I'm).v oi;Lnrs� G <br /> Legal Description(as indicated on tax statement) _ 9&'r-nro Gd <br /> Permit(s)Applied f <br /> o <br /> X_ <br /> New Building Sanitary Filling/Grading Camping Unit y <br /> 0 <br /> Addition Privy Moving Subdivision 0 <br /> F Lv <br /> Structure Use: / ��/�✓ o <br /> (family home/cabin, garage,type of addition,etc.) <br /> Directions for plot plan drawing: <br /> 1.Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). <br /> 2. Show the location of the well (W) septic tank(ST), and drainfield (DF). . <br /> 3.Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within 300 ft. <br /> 4.Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to ordi- <br /> nary high watermark of lake, river or stream, if applicable. <br /> 5. If,separate plansaresubmitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. 3 <br /> PLOT PLAN p rn v, <br /> o D o <br /> 3dPE <br /> O <br /> v <br /> t�LG XrCI � <br /> I <br /> 0 JFFIr <br /> O <br /> l _ <br /> v, N <br /> !J` z <br /> l �� Z <br /> X <br /> a� '- amaaz <br /> Z 0 i •" '� [ -i <br /> 6 N 71 <br /> nils �1 <br /> fig 0 1 O La a c <br /> a : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl-� 0_i + = <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa-� ,p\l o m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ` ' <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I : a <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap.M <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 00 <br /> O Fn f <br /> SIGN HERE <br /> (sig t o of own b ilding contractor) (date) o f <br /> ZONING ADMINISTRATOR ` 4' I ` o <br /> �N O N <br /> TOWNSHIP PERMITS MAY BE REQUIRED v o o u, rn <br /> Ogo ogo (m/f <br />