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T <br /> 4_ 1 1 '- (. r i ., , <br /> 3urnett County Office of Zoning Administrator 5) -1 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v. 3. <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v, 0* `C <br /> ihown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ccs C ►� VJ <br /> )rdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. o..., <br /> ci, :•� W <br /> lickaG R. “rt,pct mo <br /> t. <br /> „, 0., <br /> a O <br /> AWN R (please print) CONTRACTASTror CIAAlik.ce <br /> OR or SURVEYOR or AGENT <br /> c,,,i.3 <br /> 1,DDRES ADDRESS ` <br /> 1 <br /> CD <br /> 1,DDR S I ADDRESS s '_\ <br /> ell(fr)-- /VC? —6-.C4. i°\ <br /> 'HON PHONE <br /> 'LUMBER WELL DRILLER <br /> CD <br /> ADDRESS ADDRESS o 6"7 <br /> co o <br /> o' ...I.- <br /> 'HONE <br /> rt'HONE PHONEc • <br /> DESCRIPTION 4. Sanitary Facilities: . o r L <br /> • <br /> 1. Work: 2. New Building Details No. Bathrooms o • <br /> New Building .., ... Type of Construction: No. Bedrooms li E,V, <br /> AdditionSeptic Tank Size Gals. 7. 'R <br /> Sanitary Size ...l6..jft . x ....Z1.. ft. 'N <br /> Filling Height...• Stories 4. 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope ti-- r. <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate ' <br /> Privy home,ga ge, motel, e c.) Dry Well <br /> Well Shy Seepage Trench ' <br /> Subdivision Privy Crll -- <br /> Seepage Bed 0•j .‘2- <br /> _ocation of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road c,- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- - Q- <br /> ;action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 0 r^ (_ N • <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS./®S ' <br /> I1 -C. v� o <br /> 5. Lot Size: Fig. A. 6 .s._. <br /> -'.n: OI \ , , % <br />