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Burnett County Office of Zoning Administrator d CD o 0 <br /> ,APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> n� 4 o <br /> TO -RHE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y -h �Do <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use -CD <br /> I CD <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> l) 0 <br /> .r.n.�:a �................... ......................................................... ............................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .......J..?� ......r..'0 64�.....fit,........................... <br /> .......................... Q <br /> ADDRESS ADDRESS <br /> e.. 1y7 ..........S..S..LV.3............... <br /> ............................................................................... <br /> ADDRESS � ADDRESS <br /> ray. .'!. ` ..7.....��...........(b..t. �..�. 3�. &G.a� � ....... . . <br /> PHONEPHON.E................................................................................ <br /> $............................................................. .......................................................................................... 0., <br /> a- <br /> PLUMBE WELL DRILLER C <br /> . S:t. .r... ....G �.s.c. ......5..y..sS�..3............... o <br /> AD RE I ro G) <br /> ADDRESS :� <br /> 7 1. .196 LP...7- 1.5...?. o <br /> NE ..................................... .PHON.E................................................................................. <br /> o + <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° S" <br /> v F= <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building ...X•••• Type of Co%truction: No. Bedrooms `�.... <br /> Addition ...,,,,lv�a,,,,,, � Septic Tank Size Gals. ...1�d <br /> IN X <br /> Sanitary ....X... Size ..!�.�a�• ft. x ..N...'� .. ft. .......... V <br /> Filling •••••••••. Height..../.f��.. Stories ...ON......... 4a. Absorption Field Site: k• // '��r,", . <br /> Moving .......... Area ................ Soil Type .................................... <br /> GradingSlope .......................................... ° <br /> Mobile Home Perc. Rate ................................... <br /> 3. Use (describe exactly, 1 family W :? <br /> Privy home,garage, motel, etc.) Dry Well .......... .7 <br /> Well ?G k Seepage Trench <br /> Subdivision Privy <br /> J f/ Seepage Bed = � <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road 1 6 sue, <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- :>' a <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 /> L o <br /> ----------- ------------------------------ <br /> 5. Lot Size: -' <br /> Fig. A. 6. Location: <br /> ft. — ...... <br /> X ..... ft. x . ......................................................................^'..�..?-o .:'ii(iL?�? S.S,O.f�.C?........ sq.ft. ... <br /> c Cn <br /> 0 <br /> 3 o <br /> �. <br /> I o � <br /> Z- <br /> R ,��,1� <br /> 0 :z <br /> ,o 0 <br /> yN <br /> ao coo <br /> I <br /> v W WID <br /> _. C <br /> Lod- 3 r`ti c.a f'I��' s°� ��_ S'k� r a— cc..6e��'vi5t ova P i►� I�y o � <br /> 0 � n � m <br /> o o D 7D <br /> t N E I/Y sec ;o,, 35-- r TY IA.) Q I l k , 4f4. lo- LnLQ <br /> 0 <br />