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turnett County Office of Zoning Administrator v - o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H o <br /> sown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c �\ <br /> irdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a \y <br /> — cE.,e, H v O <br /> ,c..G..................... -� ..E.. .... ............................................... <br /> WNER (please riot) CONTRACTOR or SURVEYOR or AGENT m "" i CD <br /> x G.Z <br /> . •l .r.. r............................... a <br /> ...................................................................... <br /> DDRESS ADDRESS h <br /> .............................................. ........... <br /> DDRESS ADDRESS <br /> ................................................................................ .......................................................................................... <br /> BONE PHONE <br /> . ...................................................................................... ................................................................................... <br /> _UMBER WELL DRILLER <br /> ' -- ........................................................................... cn G) <br /> DDRESS ' "RESS"E' <br /> —SS <br /> ADD" <br /> 0 o <br /> ........... o' <br /> BONE PHONE Z y r <br /> DESCRIPTION 4. Sanitary Facilities: © o o <br /> o 0 <br /> Work: 2. New Building Details No. Bathrooms .......... 7 ( '; <br /> New Building . .. ••• Type of onstru ion: No. Bedrooms .......... <br /> o W <br /> Addition �OO6 Septic Tank Size Gals. .......... <br /> ........ . ..................................... <br /> Sanitary ... ...... Size . ,�. ft. x ... ft. .......... 5: <br /> Filling .•...•...• Height............. Stories ............... 4a. Absorption Field Site: <br /> \v. <br /> Moving .......... Area Soil Type .................................... :S r <br /> Grading Sloe .......................................... ° <br /> Mobile Home ••„•..... 3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> Privy .. ..... home,gar a e, motel etc.) Dry Well .......... C <br /> Well <br /> .......... ,�rr� `� Seepage Trench at <br /> Subdivision .......... ... ' Privy .......... i <br /> .................................................... <br /> Seepage Bed .......... <br /> ——————————————————————————--———————————————————————— ___ _________ <br /> ication of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road I. O <br /> :back, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ,� a <br /> :tion, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> -RUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. , <br /> o' <br /> ---------------------------------------------- vv : <br /> Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> (N <br /> co <br /> n <br /> N c <br /> O <br /> 0 <br /> -o <br /> y -A, -n "z <br /> CD <br /> °o E o z <br /> CD <br /> o <br /> Gti 70 Cl) 0 Z <br /> (u C: v —. m S. co <br /> 0 (. NaQ� = ;-7+• a <br /> ° oy.c : g m <br /> z C) <br /> © m <br /> .......... .... .z _ <br /> e of Owner or Agent Date ;�° ' p <br /> X 70 <br /> marks ................................................................................................................................................... - -n i m <br />