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Burnett County Office of Zoning Administrator 0 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 Lard Use <br /> Ordinance, Sanitation,CCode,,, and with all other applicable County Ordinances and the laws and e lations of the State of Wiso nsin. 3 a k"Q <br /> .. .1. .10........T.1.!.L..UC'�.:�.n............................... .................... �. ................................. ........ O <br /> OWNER lease print) �a/ CONTRACTOR or SURVEYOR or AGENT a <br /> 13......0. . ......a��.fi�:� C° o " r a : Q) ;0 <br /> !. ....................... ..... . .................................................................................. d b <br /> ADORES / ADDRESS <br /> F.. .c.�?.4.... e..1 ........ ..h. ...........s. ............................................................................................ J <br /> ADDRESS ADDRESS y^) :V'-:Zt <br /> \ <br /> PH�.. .................................................................................... .P H ON.E..... ..........................................I...................... ...... <br /> 11 <br /> ........................ ........................................... ............................................................................................ \ <br /> PLUMB E WELL DRILLER <br /> ADDRESS ADDRESS io 0 :O <br /> n oqLa <br /> ........................................................................................... ..PH...ONE............................................................................. ......... <br /> Z o' :r) <br /> PHONE H <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> V 2. New Building Details ���•���•� � o <br /> New Building .,/. Type o nstruction: No. Bedrooms <br /> /�Q h� Septic Tank Size Gals, <br /> Addition ..q...pp...................�....1.......... ......... 11 < <br /> Sanitary ,,, ,,, Size ...lM..6..... ft. x .... .. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... <br /> Soil Type .......................... ......... <br /> Mobile Home .......... <br /> Slope ................................ ......... ° <br /> Perc. Rate ......................... ......... <br /> Privy ,,,....... 3. Use (describe exactly, -family ;n <br /> Well ... home,garage, motel, etc. Dry Well ...... <br /> SubdivisionSeepage Trench ......... <br /> .................................................... <br /> Camping Unit .......... Privy <br /> p y <br /> __________________________________________________ Seepage Bed------�0 .-..°1. ; g(A <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched In Pig. A. mclu e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highwa 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. o' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. .........................../..................... ................. .......... :� � n <br /> rd N <br /> � (oS <br /> o <br /> O q 1 <br /> o <br /> /_ter T wrr '� <br /> CT <br /> gra <br /> 0 <br /> as <br /> ]7 N r oa < W W Z <br /> n c < <br /> E <br /> N Q a W d m <br /> '5 <br /> (11 < yC •� c m <br /> ° _. m <br /> Z O o D a <br /> o <br /> E» � _ <br />