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'`r 2 7') C. �?71 Z�1 <br /> e J a. <br /> Burnett County Office of Zoning Administrator c - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �' o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as • <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ccoo F, <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o- <br /> T rt Q o <br /> n lit �..tl'.r -, <br /> OWN (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> A o- <br /> :3--, t L k, <br /> ADDRESS � f� ADDR SS(.,).C, kQ. -1-'' V 0.4.3 <br /> ADDRESS ADD ESS 1.) <br /> 1 <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> 0 <br /> ADDRESS ADDRESS h 0 <br /> . < t <br /> PHONE PHONE <br /> H <br /> DESCRIPTION 4. Sanitary Facilities: P o ° Q, <br /> 3 <br /> (n <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details L "i <br /> New Building Type of Construction: No. Bedrooms r� CD <br /> Addition Septic Tank Size Gals. ,•Z <br /> Sanitary Size ...r .4/ ft. x ... ft. <br /> Filling Height I9 Stories 7 4a. Absorption Field Site: <br /> Moving o <br /> Area Soil Type <br /> Grading Slope <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate k. W <br /> Privy home gara•- motel, etc.) Dry Well <br /> Seepage Trench <br /> Subdivision `— Privy `5 <br /> Seepage Bed k3 <br /> % rn <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road I 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- O- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ' . < a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' <br /> \5 <br /> 5. Lot Size: j q Fig. A. 6. Location: rS <br /> 1 ft. x ft. — ..1/6) /() sq.ft. ny <br /> \ C� m <br /> U` N 3L O <br /> co <br /> L z' <br /> F, <br /> L4- �. <br /> D� � o Lko -� o <br /> Do <br /> um <br /> 'J 0 e <br /> Do cn r * (n z <br /> c a, v <br /> -O C)1 c a 3' <br /> '» oa^. c m <br /> z oo co E. 70 <br /> o = n g_ <br /> // I al <br /> NI 0 DO <br />