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Emergency/Fire No.and Road Name (r' Y <br /> Legal Description(as indicated on tax statement) - T //v Cy) Tj <br /> L k 3 +//39 Th a FFR i e S �S'T <br /> Permit(s)Applied for:' ,n ov'r 1-.o` - /S X00 S ^• o <br /> New Building ` Sanitary ` Filling/Grading Camping Unit N �- <br /> � . <br /> Addition � P(IvyMoving Subdivision V Q r <br /> Structure Use: o <br /> (family home/cabin, garage,type of addition,etc.) CD <br /> UJ <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). 0 <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. f� <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 water mark of lake, river or stream, if applicable. <br /> 5.If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. 3 <br /> PLOT PLAN R c <br /> 9 <br /> V < <br /> N <br /> O <br /> N <br /> WRSH MY Al <br /> ST R e� -r c <br /> I <br /> Y,r e 1 1 D ^" <br /> PRoPos �-� <br /> 0 W <br /> j ---� CIO _ <br /> Z <br /> J, INS wvcnraaao -0 <br /> m a a w w o a c <br /> m a4 '- am aa = <br /> a < CIO, <br /> 3 <br /> ? 0oZm <br /> 0 o <br /> M <br /> P: r: D <br /> 8€ o c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- G <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 1 am providing In this <br /> ap-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 /> - <br /> ter. W i <br /> 1ERE i 1 <br /> + <br /> (signppfure f owner orb ng contractor) (date) o <br /> EIrtISTRATOR V) ` e <br /> n 8 00� m <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° <br /> 8 g$ 8 8$ ami <br />