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l <br /> Burnett County Office of Zoning Administrator d - 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 to ated as < m 1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lind Use c �1 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wi consin. a <br /> .� —NEN �:Te►....A... ..1..... <br /> ............. <br /> .�.2N o <br /> OWNER (Please p inti CONTRACTOR or SURVEYOR or AGENT m <br /> 1 .Z.z.........FEES.ti...C.T-.......................... — <br /> . . ................................................................................. .......... a <br /> ADDRESS ADDRESS <br /> .�-I.. IGH.i.4.�J..... .... s.1.1......... <br /> Z <br /> ................................................................................. ....... <br /> ill.F�,r.�. ... <br /> ADDRESS ADDRESS <br /> ..........✓ ...:-......a.9....Z.4........... ................ <br /> PHONE . ............................................................................... .......... <br /> PHONE i <br /> ........................................................................................... ...L..DR....I.... .LLER.. ........................................................... .......... <br /> PLUMBER <br /> 'WE'L � [ <br /> ADDRESS 'A—D–D.R... . ................................................................. .......... <br /> ADESS.... <br /> .................................................................................. ......... o <br /> PHONEPHONE....................................... ............................ ....... �' .» <br /> Z r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° 0 0 <br /> 1. Work: <br /> 2. New Building Details No. Bathrooms <br /> New Building ...,, TYPe of Con ruc ' n: No. Bedrooms 10 <br /> ° <br /> Addition „�/„ ...,. p, ... ..z.. . . r? ..... Septic Tank Size Gals. .......... <br /> 'v m <br /> Sanitary .......... Size ..51.r�0}}. . I ft. x ..:7.Qjj... ft. .......... .� . <br /> Filling/Grading ,,,,,,,,,. Height.aC .. .. Stories .FF.II.......... 4a. Absorption Field Site: <br /> Moving .......... Area ...... OQ.... 3'O" Soil Type ......................... .......... <br /> .. .. ..�....... YP r <br /> Mobile Home ......... Slope .......... o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... <br /> Well .......... ho e,garage, mote , etc 1 Dry Well .......... i <br /> Subdivision �m� — Seepage Trench <br /> .......... .......... <br /> Camping Unit Privy .,,,,,,,,, <br /> 1. <br /> ___________________ Seepage Bed________ ___ Ca <br /> [� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_, should be sketched In Fig. A. Inclu e road <br /> c <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highwa inter- UJ a <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXI 3TING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----------------------- _____________________ <br /> o' <br /> 5. Lot Size: Fi A. 6. Location: <br /> -- <br /> 9 <br /> ft. x .............. ft. — ............................... sq.ft. .................................................................... .......... II hh <br /> v) d <br /> Id 7 0 0N, � <br /> ° <br /> Q T, <br /> z <br /> 0 <br /> p n r g d m z <br /> y � <br /> z o 0 a m <br /> o n 31 <br /> r r � <br /> ob n Q 17f_ 1 Sil. m <br />