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A plot plan drawWgregain to be submitted along with Ibisappllntlon. The plot plan should be down to reek or <br />dimenMonetl, and shall be on letter or legal site paper with North being at top or the page. (Show all cteas below) <br />O Property lines, road right-of-ways, and mad cemerlims including distmces to pmperry tires, mad ngM-of-ways ad mad <br />centerfines For all existing uW promised structures on line Formed, NOTE:-speeLl mollusks for privies an shown In Table 1. <br />This Ohk it not JI inclusive. <br />O OMiwy High Water Mark IOHWM)and disuacea to it hum ted proposed someone <br />O Floodplain and u211icardi hamidariw and diwncn to Nem Bum the proposed soucture <br />O Familiar summers on the travel including all deck4porebeswalkway✓eta and including any wells; most show d'wensimu forgLL <br />nems. Show dinmue to amount souctme from pmpottd sycem. Show distuue to an wells, <br />The proposed nmnure location must be slaked prior to mbn ttho this application to the Linlog Office. County staff will <br />do an onsite Halt to vmI6 Yle conditions. If the propmed wind mrelg are not staked upon County staff Ads, We permit will <br />NOT be based and It will be returned to the applicant. <br />aTabk l <br />Wei <br />Builth <br />LakelStreem <br />AdNtbnal Coon Setbacks <br />euM <br />50Ft <br />IOFt <br />TSF! <br />25 Ftm JlaWelm line <br />SeJed Plt <br />25 Ft <br />SFt <br />75 Ft <br />25Pomall able lm line <br />**OWNER OF SYSTEM AGREES TO THE FOLLOWING BY SIGNING THIS APPLICATION" <br />1. No phmhing will be iruulled in the privy%non-Plumbing memory system. <br />1 Noplumbing will 6e inwlled on the premises served by Nepnvy urdess a cotlecomplianl soil abprytion system in"] rigmnk <br />coin,orevalitsmtilmyinULn toi:mullmbarym M1ubeen ivuM <br />J. Apon for pl✓blii ebnllings shall <br />lcoiply with <br />Wisssim. CoMUTebkI UW NIhe Bumeb Cauvry CodeofOMivnea. <br />d, Prison for -PllicbuildirgssbelleomPlywi f Win. Adm Code. <br />S, PriviNmn-Plull barnsNurydidwsssedfm One a:Mtuvlemoruly purposesshall <br />cmansm. Ma ban Onfmnabove (nim[ <br />6 Pavy, enable.Wasahallbecoontrudetl ofwatmigM plastic fiberglass, or ognolithic mc:ece. MelenJssNll comply wiN imrnl nfSPS <br />JBJ.20, .12 Adm Cede. <br />y. SPS <br />firmanPrivies <br />ecp9uiy oft soormic afevault pnvywcanfo:m with SPS 38635 tequhements. The volt shall Mve <br />um,!nage capacity va It 200 galloon <br />9. The contnuof day pit mvsun onshe(wen. d Naemrd ad wiN NR 113, Wia Ads. Code <br />. <br />9. This Agreement shall be Imaging on line owner, Ibeu M1ei:s mW nwignea. <br />I (sense) declare that this application (including any accompanying drawings and plans( has been examined by me and to the heal <br />of my knowledge and belief it is true, cored and complete. 1 acknowledge that I am responsible for the detail and accuracy or all <br />Information contained In this application (Including any accompanying drawings and plans), and I further declare that 1 recognize <br />that this Information provided will be silica upon by Burnett County In determining whether to issue a permit. 1 furtheraccept all <br />Habllity'that may be a result of Burnett County relying On the information 1 am providing in this application, 1 acknowledge that l <br />wet abide by all prlvatelpublle omennets, restrictions, Inns and corememn which met apply to this pared. I agree to permit <br />county ofBelab charged with administrating county predictions; or other authorized persons to have seen to the abuve-0ncribetl <br />prmise at any reasonable time for the in a <br />yecl pp <br />X t� l <br />OWNER'S SIGNATURE: <br />(DATE) <br />SUBMIT COMPLETED APPLICATION, MAPS, PLANS AND FEE TO: <br />7410 COUNTY ROAD R, XIM <br />Sm ,wl 54872 <br />NO EMAIL OR FAR APPLICATIONS WILL BE ACCEPTED. WE ACCEPT CHECK, MONEY ORDER OR CASH PAYMENT, MAKE <br />CHECKPAYABLET0: 81BNFLLCOfINIY lANMG Forauismnce,w phonenumb k715 -M9-2138. <br />Page 2 of <br />Busmen Comply, Non-PlRmblRg Savitary Application — Rev 120U <br />