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Burnett County Office of Zoning Administrator e o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <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 m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> a <br /> .......... . . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT c <br /> CL <br /> ................ ................................................................................. .......... <br /> ADDRESS ADDRESS <br /> .... = (� W <br /> ADDRESSI ADDRESS................................................................. .......... <br /> .©S.`.5..... ....'... .5 -..................... ... ............................................................................. .......... <br /> PHONEPHONE <br /> PLUMBER. ............................................................................... <br /> .WEL. . ..L...DR...IL......LER............................................................ .......... <br /> �? <br /> ADDRESS ADDRESS L <br /> o <br /> ........................................................................................... <br /> ... .......................................................................... .......... o .: <br /> PHONE PHON.... E Z H <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o ° :C <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building ,,,,,,,,,, zype of Con tr�fctiQpn: p No. Bedrooms .......... <br /> Addition _r"W 1KrNl.1.r ,,,�(,,,, 4,Q,hGf!!.y! ,Yac.1C CVkQr+r) `Septic Tank Size Gals. ....... <br /> Sanitary .......... SizeZ/..t.T ft. x3 1.$.. ft. .•.•••..•• [ < <br /> Filling/Grading .......... Height...7....... Storie �....... 4a. Absorption Field Site: i <br /> �j <br /> Moving .......... Area ........,��J...�..4../•-. ............ Soil Type .................................... P­ <br /> 0 <br /> Mobile Home Slope .......................................... �* <br /> .......... <br /> Privy .......... 3. Use (describe exactly, i -family Perc. Rate ................................... <br /> Well .......... C.) <br /> Dry Well .......... i <br /> Seepage Trench .......... <br /> Subdivision eSM't <br /> ........ ............ Priv <br /> Camping Unit ... ...... ........... .................. y .......... <br /> ........... ...... Seepage Bed .........I DO <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in FIg. A_ Inclu e 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 EX STING V{I <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N <br /> o' <br /> 5. Lot Size: Fig. A. 6. Location: :(CI <br /> ................ ft. x .............. ft. — ............................... sq. ft. ....................,................... .......................... ........... <br /> Z 3 c Ta. <br /> � N <br /> 0 O <br /> \YI D ��PP 3 <br /> /A( 7 <br /> / O O <br /> z <br /> ZY /S <br /> �/ 7s ,, i <br /> � <br /> 7z <br /> �' 0 15 0 <br /> d loaf zz5 <br /> z Zs <br /> to Z <br /> O <br /> LD. <br /> rr <br /> Z OO y n <br /> o n ro 3 <br /> ,p <br /> 0 z <br />