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Burnett County Office of Zoning Administrator c -E. co o z <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 H - <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co m V <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. -, a <br /> Rvia,k-c-.D F i:f.A) Rediii-ak P rtni 6— <br /> N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT co <br /> q.1.t.....T.m. sio £ 4)E- (? r 1 7'I m �Se,,sll c a rRESS /� ADDRESS M a, ." T� <br /> �," ! i)id CS-1 - t-c,-t-�v"4 ! ' !A) SS!23 4� (�� - <br /> ADDRESS ADDRESS ,` <br /> PHONE PHONE NI t <br /> PLUMBER WELL DRILLER <br /> 0 <br /> ADDRESS ADDRESS <br /> �_ o O� <br /> PHONE PHONE o • <br /> DESCRIPTION exlSti -�DJo4t - o <br /> kbB1•wra� 4. Sanitary Facilities: l O • o ,« <br /> 1. Work: No. Bathrooms 3 <br /> 2. [\}eag Details •••• <br /> New Building Type of Constr ction: No. Bedrooms 4.. .0 P ` <br /> Addition `} )CC C) Septic Tank Size Gals. /OQ N <br /> Sanitary Size ..../, ft. x a-0 ft. <br /> Filling Height . Stories / 4a. Absorption Field Site: <br /> Moving Area "T.,?. sA 0 t.. " Soil Type <br /> Grading Slope 2. <br /> Mobile Home 3. Use (describe exactly, 1 .family Perc. Rate cS <br /> Privy home,garage, motel, etc.) Dry Well ^• <br /> Well i4D'b iirr 010 - sc.0 cid Seepage Trench i <br /> Subdivision /?pµ ? Privy <br /> r Seepage Bed f <br /> ks cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road o- <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 <br /> N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a• <br /> 7 <br /> 5. Lot Size: / Fig. A. 6. Location: <br /> (A.Q ft. x 4I.,.U.. ft. - .),�t.5'Oc? sq. ft. . <br /> L Co* Fait_ #1, __ cn <br /> ......- _ .. n <br /> C) <br /> N o. <br /> O 7 <br /> 7 <br /> cn N <br /> try\ ,;',A.,Vet•-\)‘-t--\ <br /> c; <br /> + r-- j <br /> S <br /> ir---- 1 <br /> z <br /> m <br /> co <br /> 6°4-1rJ Abl"tyn� 1; - <br /> �t�3r co <br /> CI <br /> v. .- <br /> I �j, . r 7*�co <br /> � ��'\ 0 7- 7 < —� 7 -• <br /> co. N a a< — '+• a <br /> '6p•i c m <br /> zooms < 5. o� gm <br />