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Legal Description (as indicated on tax statement) <br /> n O <br /> O <br /> Permit(s)Applied for: 0 '. <br /> Dwelling Addition Filling/Grading Camping Unit <br /> o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ' <br /> Garage J <br /> Structure Use: C4 <br /> 0 <br /> (family home/cabin,garage,addition, etc.) <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> Z Show the location of the well (W),septic tank (ST),and drainfield (DF). 3 <br /> 3. Show dimensions Infest of the following:(a)building to all lot lines,(b)building to center line of road,(c)building2 c <br /> measurement to the ordinary high water mark of lake,stream,or river. O <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m H <br /> dated by the owner. C I <br /> PLOT PLAN �. M <br /> a qq �� l <br /> o I <br /> Cn <br /> 1/0 ► o c,) <br /> v � <br /> fN <br /> f <br /> • <br /> Z <br /> DIC <br /> a_ <br /> CD (0 <br /> m <br /> m. . a� g— 'ay a1D M <br /> < < . H o m $ <br /> 1L VCJLI� f 0L T� m� y- <br /> -b�— a .. : m <br /> 8 <br /> C <br /> C.L <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know!- ° m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- i «m N t7 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m v, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ W $ <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- N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> ro <br /> access to the above described premises at any reasonable time for the purpose of inspection. $o <br /> � xE <br /> SIGN HERE <br /> (snat a of ow building contractor) !date)-= ; c s <br /> ZONING ADMINISTRATOR g <br /> JUN 161 «�N«N« « ,t <br /> TOWNSHIP PERMITS MAY BE REQUIRE[ I I�I O ulcn . y o o S <br /> 8888888 <br />