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3urrrei't County Office of Zoning Administrator Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< H o <br /> hown'herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c� c)rdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a '" <br /> )WNER (Please print) ........ ......... .. ....................... y <br /> CONTRACTOR or SURVE OR or AGENTIDr— <br /> ` je.tl <br /> ADDRESS �/........f ADDRESS J....-.. ..�.......1...:. .. . .. - �' <br /> E6Fi' S AD...........RES....S......................... ............................................... (� <br /> D <br /> HO N.........................................................'�................. ........................ ......... <br /> PHONE <br /> LUMBER WELL DRILLER.................................................................... <br /> .� <br /> ......... o <br /> DDRESS � � ADDRESS \ <br /> m G� <br /> .fq-.... .0. <br /> HONE ��.......................................... <br /> a <br /> U` 0 ` <br /> .......................................................................................... a <br /> PHONE <br /> DESCRIPTION Z H r <br /> 4. Sanitary Facilities: o 0 0 <br /> Work: No. Bathrooms . v <br /> 2. New Building Details .......... :� <br /> New Building • Type of Construction: No. Bedrooms ... ' <br /> Addition „•„.....„Ult?Ol flH1C w Tank Size Gals. .... <br /> .. <br /> Sanitary _/ fYt�.tai�6a�� } < <br /> Size ... a� ft. x ... .Y-.. ft. <br /> Filling Height.... ...leget4y►!,! ..... 4a. Absorption Field Site: <br /> Moving ....... .. Area ............1.Q...�. .............. Soil Type .... .. ............................ � r <br /> Grading .......... Slope . ...... .. .11.j.h��� /� 0 <br /> Mobile Home .......... 3. Use (describe exactly, 1 family Perc. Rate <br /> Privy ,,,,••,••, home garage, motel, etc.) Dry Well •,,,••,,,, <br /> Well Seepage Trench # OI \ <br /> Subdivision Privy <br /> Seepage Bed <br /> ------------------------------------------------- ------------ <br /> rn 0 <br /> )cation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road ?� <br /> tback, 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 S <_ <br /> -RUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------- GJ----------------------- <br /> Lot Size: Fig. A. 6. Location: q t ~ <br /> .—y n <br /> ft. x ..1. D— 4> <br /> ft. — ..,Z. 730 Is ft. .......l..l� <br /> T'Q <br /> �� I <br /> ID <br /> N p' <br /> O <br /> 7 <br /> y� <br /> Z <br /> CD <br /> CD <br /> � cnrv� v�oo <br /> o c m., <br /> a' cn <' °'f ' � � <br /> E.C 11� � m <br /> Z oo' m : V <br /> ID M <br /> . ........... ...... ....... .......k3. <br /> p <br /> Cture Owner Agent Date ° C <br /> X <br /> marks <br /> -n m <br />