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;166(90 Lo n Lone <br /> Legal Description (as indicated on tax statement) — <br /> $ <br /> Permit(s) Applied for: <br /> 0 <br /> o' < <br /> DwellingAddition Filling/Grading Camping Unit o <br /> Accessory Building _X� SanitaryZ o' <br /> Garage ing Privy Subdivision ° 0 <br /> /l a <br /> Structure Use: GQrCLA a <br /> V (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). X 0 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). C o <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within an <br /> 300 ft. rn <br /> � Z c <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building n P` n <br /> to lake, river or stream, if applicable. M w <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C o <br /> dated by the owner. I 1 <br /> PLOT PLAN ` <br /> ur <br /> N � a <br /> 0 <br /> llax3a � w <br /> Z/o7 , 19or <br /> _ <br /> zS' <br /> F� <br /> �8 Ng <br /> )ay tix3a y'!3 ' f <br /> m (nrnV N Dn] <br /> F ST ^ '_. a 0. m Q. m m <br /> D m. an a _ a <br /> P fes : y <br /> N'. m <br /> he best of my knowl- <br /> I declare that this application(including any accompanying schedule)has been examined by me and to t <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> ` n' <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor• m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit."t, <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• ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for theu v, <br /> p rpose of inspection. g <br /> m 3 <br /> in <br /> SIGN HERE ✓�/ / // / � /9 �qq� w $ <br /> (signature of owner or building contractor) 00j <br /> -� (date) )vwi3 v <br /> ZONING ADMINISTRATOR f'AA/ g <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> In <n �n ut <noo .`cS' m <br /> gggggggg UM) <br />