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Burnett County Office of Zoning Adminis rator 0 0 <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 to ated as < _ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L no Use c <br /> Ordinance, Sanitation�Code, and with all other applicable County Ordinances add the I� in <br /> s and regulations of the State of W7 cous _ 3 <br /> . ... <br /> OWNE LI lease print) CONTRACTOR or SURVEYOR or AGENT a <br /> .......1.. ........................... 2<?.o-.Z.�i. cal.r. .R!.NE......s�... ..N.. .......... <br /> a r° <br /> ADDRE,$9t ADDRESS Q 1 /� 5.5.33.0 <br /> � C / °f <br /> ADDREss...... . ��..../..:.:.N.f.......s..��..���......... . .[ LIl.....'\.l!Gr..L�..�....rMA/.......... .5. ..3. f� <br /> ......... . .. (�. .. . _ l <br /> ADDRESS L� / �/ <br /> ........................................................................................... .PH ONE.�.......Y.•{Y.I ......../. 5.. ..7..................... .......... <br /> PHONE <br /> ........................................................................................... . ............................................................................... .......... :O <br /> PLUMBER WELL DRILLER <br /> O........................................................................................... ................................................................................. .......... <br /> ADDRESS ADDRESS —' <br /> o <br /> ........................................................................................... <br /> m G7 <br /> PHONEPHON..E....................................... ............................ .......... � o� .: <br /> DESCRIPTION a <br /> 4. SanitaryFacilities: o <br /> 1. Work: No. Bathrooms <br /> yy 2. New Building Details ��������• <br /> New Building ,/X. Type of Construction: No. Bedrooms .......... <br /> Addition ,,a.�A4 E Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ..bt. 7....... ft. x ...a-....... ft. .......... <br /> Filling/Grading .......... a+SllHeight....V'n Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... r <br /> 0 <br /> Mobile Home .......... Slope .......................................... � .. <br /> Privy Perc. Rate ................................... i <br /> .......... 3. Use (describe exactly, i -family <br /> Well hoJ e,garage, motel, etc.) Dry Well .......... <br /> Subdivision .,,...,,,, l� Seepage ch .......... <br /> F <br /> Camping Unit .......... . .. ...... Privy .......... j— <br /> .................................................... Seepage Bed 11 <br /> ------------------------------------------------------------------ --- <br /> o .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched In Fig, A. Indo e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a in ghwa inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXI 3TING L <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. r '^ <br /> o. <br /> -----------------------------------__--__--_—_-- .d 3 <br /> 5. Lot Size: Fig. A. 6. Location: 0 <br /> ft. x .............. ft. — ............................... sq. ft. <br /> to <br /> L A K6 <br /> p <br /> N p <br /> o <br /> SECrIc s0'--7a` <br /> C IfJ <br /> 4a -5o' /tel <br /> eroo-E ny QI <br /> q y-1 0 <br /> c � <br /> .3 m <br /> m <br /> 91,0 <br /> rp C Lr` 9 < m m N <br /> _ ..... 6 Nd C: <br /> �-- 0 -------_. 0 0 o n m <br />