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TO THE ZONING ADMINISTRATOR: The undersigned hereby ma es app ica ion ora ermi r Mftr <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use mU <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> �1.. {'.. !9t?4f!..... .:.... F <br /> o <br /> 1. ....................................................................................... <br /> • a <br /> ... <br /> Y7��N,rE•,R IPI ase print) CONTRACTOR or SURVEYOR or AGENT m m <br /> CL <br /> PAHDODNRESS '^ �.•7............................................ <br /> ADDRESS <br /> .TIEN.........WA.7....................................... ................ <br /> ............................................................................ <br /> A.DREDR SS. ADDRESS <br /> '-7rKL71 .............. ..................... ............... <br /> PHONE m <br /> `( <br /> ........................................................................................... ............. .... ......................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .A..D..... ..S.............................................................................. O <br /> • ADDRESS DRES.... <br /> o :S <br /> PHONE PHONE Z N <br /> DESCRIPTION 4. Sanitary Facilities: ° or <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms .......... a <br /> Addition Septic Tank Size Gals. .......... <br /> . .... .................................................... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................ Soil Type .................................... i E r <br /> GradingnoSlope .......................................... <br /> A"rri '(o y [ € <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy ......••.. home garage, motel,etc.) Dry Well <br /> Well .......... E(j L1i...... ..... .... Seepage Trench .......... <br /> .... ..Cl..... ��'D �f?C..H� Priv <br /> Subdivision ......•... ATrAa4EV (r,)ITN y ......•••• <br /> Seepage Bed <br /> --------------------------- WP��WLI�)---------------------- <br /> Location 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 property g y <br /> yard dimension and location and setback from all bodies of water. Ifis located at a highway inter- 4 <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 /> 0 <br /> AfiWOKIIt Fig. A. 6. Location: cK3ort i6LU� t <br /> 5. Lot Size: p p <br /> (.7/�...... ft. x .1.7..a..... ft. — .. �.[. ............. sq.ft. 0(x.1. <br />