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.n not County Office of Zoning Administ ator w o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and Ioc ted as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use e ;� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin, 3 a 1 <br /> a <br /> ..../. v..C.s..k..... Q.y.3.7. m...Jv— ................. ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> �1.7.a . ........1 . ....n.r. ....N..., � . .................................................................. . <br /> ADDRESS ADDRESS � T <br /> � G m <br /> .. . . .4 �...`.;.�L......Lf fi1........ ... ................... ................ <br /> z <br /> ADDRESS ADDRESS <br /> 1a an <br /> PHONE PHONE <br /> /zr�• n <br /> F.,. . ... ............................................................... ......... . . . . ............................................................ ......... <br /> PLUMBE� WELL DRILLER <br /> ADDRESS ADDRESS <br /> o y <br /> ........................................................................................... . ............................................................................... ......... o ,» <br /> PHONE P..HONE Z H r _ <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° �• <br /> 1. Work: 2. New Building Details No. Bathrooms o '� <br /> New BuildingT No. Bedrooms a <br /> .......... ype of Construct) <br /> r m <br /> Addition •••. •,••• —�.�•.,��„••• •••••• Septic Tank Size Gals. ...... .. '• <br /> .............. . G < <br /> .. J <br /> Sanitary Size ft. x ft. �• <br /> Filling/Grading •......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ......................................... Soil Type .......................... ......... r <br /> O <br /> Mobile Home Slope ................................ ......... •. <br /> Privy .......... 3. Use (describe exact) , 1 -family Perc. Rate ......................... ......... (0 <br /> Well ..•...•... home,garage, motel, etc. Dry Well ......... l <br /> SubdivisionSeepage Trench ....... <br /> Camping Unit .......... .................................................... Privy <br /> Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. Inc!u e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- a '' <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (r. <br /> ------------------------------------------------------------------- --- <br /> 1, <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. .................................................................... .......... I :� <br /> N o <br /> •h tN <br /> O 4 <br /> Ell Z4 <br /> y15 <br /> s <br /> Z � <br /> 0 <br /> d <br /> 3 <br /> J ci <br /> U 77 rn r v m m <br /> f <br /> O V G C M <br /> Z o o B <br /> 0 m <br /> in <br /> tao <br /> o <br />