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Burnett County Office of Zoning Administrator C. 7 H Z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> d - <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as -` H ch <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co c 9.) <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o- i v\ <br /> /-- - '7' a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT aCD <br /> d /,'0 • H.6 YT mi'-.- , Q <br /> ADDRESS ADDRESS ° . L ;. <br /> .ST /47"4 7 .MA, 5-5./D I- <br /> ADDRESS ADDRESS §� <br /> PHONE PHONE N. <br /> N <br /> PLUMBER WELL DRILLER <br /> 4 ADDRESS <br /> ADDRESS o G) <br /> o k, <br /> c) < <br /> PHONE PHONE z o • <br /> DESCRIPTION o <br /> 4. Sanitary Facilities: • o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> cl <br /> New Building X. Type of Con truction: No. Bedrooms 0 <br /> co <br /> Addition p65-ri.,--,-- Septic Tank Size Gals. <br /> Sanitary Size ...so/c2.... ft. x P,2 ft. <br /> Filling Height Stories / 4a. Absorption Field Site: <br /> Moving Area .S‘ 6 Soil Type <br /> Grading Slope 0 ° <br /> Mobile Home 3. Use (describe exactly, 1 -family <br /> Perc. Rate �` <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well n,4A-5 ,,,y _ Seepage Trench N <br /> ,./ <br /> SubdivisionPrivy K <br /> Seepage Bed <br /> cn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road `ti a- i('Ni, <br /> • <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- r.41 0- <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. ti <br /> I 0 <br /> 5. Lot Size: Fig. A. 6. Location: O <br /> ft. x ft. — ' 9 4-'fl-i2-7 sq.ft. 4: -.k' &/-1.4 442--c-- I), r',-) <br /> p. <br /> cn <br /> C) <br /> ,-. <br /> IV It o <br /> ) , m <br /> 5. <br /> co <br /> o <br /> u, <br /> -o <br /> I <br /> v, <br /> 0- <br /> -6 <br /> z <br /> o �? F-_-_)-, <br /> 0 <br /> a °, <br /> coo <br /> V <br /> m° N1— 7 z <br /> CCU d c m <br /> o CD. N Q -< 0 - <br /> • <br /> — - Q <br /> -O c 3i <br /> r+ o 91 <� ti * m <br /> z Co `D : .ifDm <br /> o 0 <br /> 01 <br /> - n - • <br /> :j, o i <br />