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Burnett County Office of Zoning Administrator W CD o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ° <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - c i <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> r+ <br /> m <br /> 5. O <br /> .................... ...... . ...:� N <br /> .......................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT Q <br /> ADDRESS ADDRESS + <br /> pp <br /> 4f*. / i. may.a.. .��............... ................................................................................. :Q <br /> ADDRESS ADDRESS \ <br /> ........... .............................. ........................................................................................ , <br /> PHONE PHONE <br /> .. ..................................................................................... . .......................................................................................... :W <br /> PLUM.. BER WELL DRILLER <br /> ............................................................................ . ...................................... <br /> ESS .................................................... <br /> AD DR 0 . <br /> ADDRESS <br /> 0 on <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 7 : <br /> 1. Work: 2. New Building Details No. Bathrooms rv: 0 �. <br /> No. Bedrooms ° <br /> New Building ,•,••„•.. Type of Construction: �: 0 ` <br /> Addition ;,,,••• W.,4,7 lcr�j}�?1C�/�?�Qy� � Septic Tank Size Gals. ......... � <br /> Sanitary �..D.... ft. <br /> Size ..?..�i!.. . ft. x ..... <br /> Filling ....•••..• Height..l. .... Stories ...,,1........ <br /> 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... <br /> Grading .......... Slope .......................................... ; <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .� <br /> /`i .f�..d.. .................... <br /> Subdivision Priv Y ..........I 1 <br /> .................................................... 41 <br /> Seepage Bed <br /> Location of proposed structures and existing structures well,sewage systems, roads,etc., should be sketched in Fig. A. Include road I <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter-b� (5 <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. C �� o a <br /> ------------ ------- <br /> -- v <br /> 5. Lot Size: �� Fig. A. 6. Location: } l <br /> ................ ft. x .............. ft. — ............................... sq. ft. .......................................................................... o i <br /> C' <br /> JCD <br /> Nf� 0 <br /> G N t —' <br /> �, l! O <br /> �O <br /> ijJL <br /> ro <br /> m -n <br /> 0 <br /> z <br /> 0 <br /> --- ° <br /> Z <br /> m <br /> LD, N Q Q <br /> a cn < � : <br /> oL m <br /> z oo' � D <br /> o <br /> �/i'd�0 Sf%J .� •can � cn � <br /> Cr <br />