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6 )-V) . <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and loc ted as < — <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Laid Use mXJ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsin. <br /> .....64erzll.....C 4TYub�t^....................... ......17e o.t c/ys...........Y1? l/��. +� ..................... ......... o <br /> OWNER (please print) CONTRACTOR 6r SURVEYOR or AGENT <br /> . 3.......... ........L�k .r.yp_*.......................... ................................................................................. .......... a y� j/1 <br /> A ,pKESS ADDRESS <br /> l.:L as..4,vi ll127!7..-........;5;5Z�3......... ................................................................................. .......... <br /> ADD ESS ADDRESS <br /> PHONE ' <br /> I <br /> Hi5l. ......... ........... d0 <br /> PHONE <br /> ........................................................................................... . . . .......................................................................... .......... <br /> PLUMBER WELL DRILLER <br /> p <br /> ADDRESS ADDRESS m � <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> 1. Work: No. Bathrooms v <br /> 2. New Building Details o <br /> New Building ..,,.. ., Type of Construction: No. Bedrooms .......... a <br /> Addi io �� „•.••••, Septic Tank Size Gals. <br /> ....•....•..• <br /> Sanitary .......... Size ....«.... ft. x ...... ft. .......... <br /> Filling/Grading .......... Height........... 4a. Absorption Field Site:Storles ....�... ..... � . <br /> � .. Soil Type ......................... ..........Moving Area ....... .....� <br /> .......... m <br /> O <br /> Mobile Home . ..... Slope ............................... .......... ®ffb -� <br /> Privy „ ........ 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... <br /> Dry Well .......... <br /> Well ........., h me,ga/rage, motel, etc.) Seepage Trench ' <br /> Subdivision ......... .... • t.A/77YN...Q.!t..`:tl....�Gh "- <br /> .......... .�.F .646&�....� Privy .......... zJ <br /> CampingUnit <br /> Seepage Bed <br /> _______________________ _________________________________________ ___ � to <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig. A- Inclu e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y inter- O- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING Qj <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ___ O <br /> 5. Lot Size: a /� Fig. A. 6. Location: <br /> ....///...... ft. x ..B .U.. ft. — ..>?.B�Y.� s9.ft. ..........WW.-... <br /> q1 N. ....1 .................. <br /> ..................... ......_... <br /> a ,0s ecu-v Aon / ism v � <br /> ( /d to 1i�ZZ.�'3 Goa Le% 2> <br /> D C” o <br /> t 41 1 <br /> >-1 <br /> o <br /> B T Z <br /> _. <br /> �zood M , ommno to <br /> — m Nan •c o. <br /> cri <br /> Z O o m D n R <br /> �— o O n m <br /> A <br /> IT <br />