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M � <br /> arnett County Office of Zoning Administrator W CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> awn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> cD <br /> dinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 Q- 7 <br /> a .—. <br /> ��``'' �l <br /> ...............'C T ............................................................................................ m lCD <br /> �'G 3 <br /> NNER (please print) CD <br /> CONTRACTOR or SURVEYOR or AGENT <br /> a <br /> Q <br /> S' c� .........��..�...��..... ..ray <br /> ................. . <br /> 11RES ADDRESS <br /> + � //Q :, 7 <br /> `!...+!,(.` ............:c`?............h4.. .................. <br /> DRESS ADDRESS �. <br /> ` .d - 3 �. ...................... <br /> ... .... <br /> iQNE PHONE <br /> .................................................... � W <br /> -UMBER WELL DRILLER <br /> .......................................................................................... C iC <br /> DDRESS ADDRESS n O <br /> ,+ < <br /> ........................................................................................ ........................................................................................... o <br /> TONE PHONE Z :3 r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms <br /> Work: 2. New Building Details "" ""' :� �0 <br /> New Building .......... Type of Construction: No. Bedrooms •. •••• <br /> �►+ <br /> . <br /> Septic Tank Size Gals. .... <br /> Addition .......... .................................................... .... <br /> Sanitary 0 <br /> Y Size .............. ft. x .............. ft. <br /> ✓�"' 4a. Absorption Field Site: ' <br /> Filling .......... Height............. Stories ............... <br /> Moving Soil Type .................................... r <br /> .......... Area ........................... ............... �• ' :5 0 <br /> Grading .......... Slope .......................................... <br /> Mobile Home 3. Use (describe exactlyS <br /> family <br /> Perc. Rate ................................... ' <br /> Privy home,garage, motel, <br /> Dry Well <br /> Seepage Trench <br /> Well .......... ......................................... ' <br /> Subdivision Privy p r <br /> ------ Seepage Bed <br /> -------------------------------------------- ——————— <br /> ► <br /> C <br /> .ocation of proposed structures and existing structures, well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road s <br /> =tback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- v' <br /> =ction, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `J <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- rf,` :IA <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — .. . sq.ft. � <br /> i� co <br /> N o. <br /> O <br /> Lo <br /> y 0 <br /> 0 <br /> T � <br /> N <br /> C <br /> a � . <br /> aD <br /> -cr <br /> cn r D cn m Z <br /> m c m �. c m <br /> _LD N Q Q <br /> 'O 01 < <br /> �-' p u,' wG ca C r <br /> Z O O• fD (D <br /> G �— 3 <br /> ��.........� ................ o < <br /> Signature of Own r or Agent Date '-' <br /> f _ X <br /> i i - <br /> T <br /> Remarks ...:..................................................................................................................................................................... CD <br />