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Burnett County Office of Zoning Administrator 3 CD O o <br /> _ --APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CDI ID <br /> R}'1 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> O <br /> .. .. '.... ?x�... .T.�i................................... ..¢: ..J�rC. .., .r�..�........................ <br /> OWNER (please print] CONTRACTOr SURVE OR or GENT n r+ CD <br /> � 1 <br /> / <br /> AD <br /> ., <br /> ADDRESS Y <br /> DRE SS �+ <br /> . �.h.�...., .�r..........1 v �. . ............... ......................................................................................... <br /> ADRESS ADDRESS <br /> `"-. .. . ........�.h.L..V....................... ......................................................................................... <br /> PHONE (� PHONE <br /> ..... ........�. ..")^....�0..1/. .................................. .......... <br /> WELL DRILLER , <br /> al..C./..'tom.. ....... ....... . ... ../.... ............................................................................................ �. <br /> o <br /> ADDRESS ADDRESS CD o <br /> < <br /> .,. ; <br /> a.�..r.� .. '- ....l�L�......................... 3 <br /> ,F' iM6 PHONE Z y r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details " ' ` o <br /> New Building x Type of Construction: No. Bedrooms .......... D <br /> F �, <br /> ....... <br /> Septic Tank Size Gals. <br /> Addition .......... .. .:):'Y.►............... ...... .......... � <br /> Sanitary Size ..`q�..t�l.. ft. x ...Y.lrl... ft. ......•••• <br /> Filling .......... Height........ ... Stories ............... 4a. Absorption Field Site: <br /> g Soil Type r '•.................................... . . <br /> Mown .......... Area ........................................... o <br /> Grading Slope .......................................... 7 <br /> 0 <br /> 1 ' <br /> .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ?, ; <br /> Dry Well <br /> Privy home,garage,motel, etc.) i y <br /> Well Seepage Trench .......... 9 c <br /> .......... .. ............ <br /> Subdivision Privy <br /> Seepage Bed .......... C! <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <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. ?� NO�7� . <br /> -------------------------------------- <br /> 5. L /Size: Fig. A. 6. Location: �) U <br /> .U.O.... ft. x ... .`S.U ft.— ............................... sq.ft. <br /> C <br /> Cn <br /> Cb <br /> N c0 O <br /> LC <br /> o <br /> \ d <br /> CD <br /> M Cn Z <br /> CD CD <br /> m, Naa< <br /> a U1 < � <br /> Z oo,CD T. <br /> o . <br />