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l c?G yi�1/71 <br /> — <br /> Burnett County Office of Zoning Administrator o✓ o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> ^ 0 7—i <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N -" <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin 3 C- <br /> CI <br /> - <br /> a DiJ <br /> ...pF1V.iD .................................. ........ PU. ..................................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> i.. .....�V <br /> ....�ONA <br /> ADDRESS ADDRESS I <br /> T.PAV.4�....M.AI........55�.� .............................. .................................................................................. ......... = p <br /> ADDRESS ADDRESS <br /> GI2,. 138.-,oO2o <br /> .................................................... .PHO'H-0.NE.......................................................................... ......... <br /> PHONE <br /> NdN ............................................................... ...... l�.iJ.4-......................................................... ......... <br /> PLUMBER WELL DRILLER p <br /> 0 0 <br /> ADDRESS ADDRESS n o (rl <br /> —. <br /> ........................................................................................... .................................................................................. ......... o <br /> PHONE PHONE Z �', r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms �, o (nH <br /> New Building .., „ .,, Type of Construction: No. Bedrooms .K)IiI i � �n <br /> Addition .,.x,,, ..WOOD .IF&AME.................. Septic Tank Size Gals. ......... ;},I fr� <br /> f <br /> Sanitary .......... Size .2.11...... ft. x ...2.6t.... ft. ......... <br /> 4a. Absorption Field Site: ' <br /> Filling/Grading ,,,,,,,,,, Height ...Z: Stories ... ........ p: in 6i <br /> � A X 2. ........ Soil Type .. ... .. .. y..►r� ......... :G r <br /> Moving .......... Area .................. .I........... '^) E— G p <br /> Mobile Home Slope ........ .�.!.............. ......... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ......................... ......... <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> Subdivision A�QIAN�... .[�.Q. rC.Ol7Q-TD Seepage Trench .......... ' <br /> .......... . . ... ......... - <br /> Camping Unit .......... Privy . ....... - <br /> Ex.«ii.n,a.....�1�.!l A�,~.... <br /> ------------------------- Seepage Bed . ....... <br /> r—b2 SUfLA >✓ a w�R.KSN <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig_ A- Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highwav inter- i- cc <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL ETI 3TINU IN :3 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. --- IIN i` o <br /> 5. Lot Size. Fig A. 6. Location. <br /> .2..04 ... ft. x .5.-M. ft. — .....Zft. ........................................................... r <br /> Cr <br /> 0 3 <br /> 1`Ill LPI RD N Z s <br /> DEvt�s LRkt= (J12wc o tJ! ::lot <br /> C ko bLASr PROP��N C <br /> cooNr,o2S O N <br /> 0 o I_A✓Etd <br /> IA PVgUL <br /> N too, �ccESs c a <br /> � r m b <br /> paoll <br /> N N � <br /> 1 �r C NN XlS O <br /> G GAIL <br /> p N -- � �� ' €6 <br /> Y - - - - - - - - - - - - SITE <br /> OfL1UEwAY <br /> 7J N r v :E m W Z <br /> m A a <br /> c : <br /> CAMBCLLS' PfIOPEQT/ o' N m m v <br /> M <br /> Z o0 <br /> o n <br /> m <br />