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e/ C7H -C,rrYLp, <br /> Burnett County Office of Zoning Administrator _y 0 o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. * . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '.Z H o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cow Fo <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a i_I <br /> ;+ ,v 0 <br /> ,Si.4 e,f /Q✓6.6 4 rt- T e-,F...F...1.-1 4 k.6 Ca h r5.r N iii c. <br /> OWNER (please{l.?se�print) CONTRACTOR or SURVEYOR or AGENT a N <br /> ADDR .Stf-e IlV..1 1 <br /> .6 s ADDREr 1 m <br /> t P : <br /> IA/..u53.,< r e W t>•S.. c'/P23 <br /> ADDRESS ADDRESS <br /> PHONE PHONEel <br /> nl <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS C C <br /> PHONE PHONE Z z g. • • <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms 3 <br /> New Building Type of C nstrti n: No. Bedrooms <br /> uc <br /> Addition „I. C ed/, ,,� 4 t k Septic Tank Size Gals. <br /> Sanitary Size i.2- ft. x ..3..2. ft <br /> Filling/Grading Height Soil T Stories 4a. Absorption Field Site: <br /> .. e <br /> Moving Area a.. ...�5�.f ........ Type <br /> o <br /> Mobile Home Slope ,-, <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate <br /> Well home,garage, motel, etc.) Dry Well <br /> Subdivision Seepage Trench <br /> Camping Unit Privy <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 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway 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. `� <br /> 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq. ft. <br /> cn <br /> co <br /> n <br /> 1 rr <br /> 1 q 3 0 <br /> V <br /> o U1 <br /> Zt'.f--��P°s a h —10 <br /> v � tc/< <br /> ti <br /> ' ;1, f yistric CO <br /> 90 <br /> i No �_ `, <br /> 'NI � G T� ` 5 c,,,-74. z S Q <br /> 0 <br /> Sk 0 <br /> 0 <br /> CD <br /> Ip2 <br /> nN r u rn z <br /> cER 6n < _ . F <br /> a ` _a• Nc mg.y N.) y .0 <br /> • <br /> oZ o o a 5 M <br /> . 01 — : "'( <br /> A O TI <br />