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Burnett County Office of Zoning Administrator d - - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 <br /> d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and loc ted as m o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Laid UseIs C <br /> Ordinance, Sanitation Code, and wi all other applicable County Ordinances and the laws and regulations of the State of Wis onsin. ma <br /> ..................... .....�2t/,..... .................. . . . ............................................................................ ......... <br /> OWNER (please print) C O C <br /> Ox �� CONTRACTOR or SURVEYOR or AGENT m m <br /> A��s...1...... .. ......� ......... ........ <br /> .............................................. .................................................................. . <br /> l r'V�SG ADDRESS <br /> l <br /> .. .................. .�................................................................. ........ <br /> ADDRESS ... . ............................................................................ . <br /> ��� ADDRESS 1 <br /> ... O. . ................................................................................ ............ ..................................................................... ......... t�J <br /> PHONE PHONE i ir./a <br /> ........................................................................................... .W....LL DR.............LER............................................................... ......... � l <br /> PLUMBER EIL <br /> ........................................................................................... p <br /> ADDRESS . ................................................................................ ......... <br /> ADDRESS <br /> m G <br /> ...... .................................................................. .......... < L <br /> n o <br /> ...... <br /> PHONEPHON..E...................................................................... ......... 5� <br /> r i <br /> DESCRIPTION Z <br /> 4. Sanitary Facilities: ° o o <br /> 1. Work: No. Bathrooms <br /> 'o <br /> �/ 2. New Building Details ........ <br /> New Building „/\ Type of on ruction: No. Bedrooms ....... a <br /> m <br /> Addition .......,�.�• i Septic Tank Size Gals. ......... <br /> Sanitary .......... Size ....A.�ft. x ...3. ..... ft. ......... <br /> Pilling/Grading „ ,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .......................... ......... <br /> ........................................... r <br /> o <br /> Mobile Home <br /> .......... Slope ................................ ..... ... �• <br /> Privy ....,,,,,, 3. Use (describe exactly, 1 -family Perc. Rate ........................I ......... <br /> Well home, gar ge motel, etc.I Dry Well ......,,, <br /> Subdivision �rGFL Seepage Trench ..... �1 <br /> ........ . ............................... _. <br /> 9 <br /> Cam in Unit Priv <br /> Y <br /> .................................................... Seepage Bed <br /> Camping <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc_,should be sketched In Fig. A. IncJud 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- <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. l <br /> Tt --------------------------------- I, . <br /> 5. Lot Size: �y fte-��� Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq. ft. ..................................................................... ........ <br /> 01o <br /> ” s <br /> K a <br /> o <br /> s <br /> iLl <br /> 1\ 1a <br /> m <br /> 0 o 5 D n m <br /> D <br /> m <br />