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Burnett County Office of Zoning Administrator Iuo Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 2. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and loc ted as '� m o •� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use C _ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. v. <br /> 'i �/ �/ n 3 <br /> Cc <br /> 6OVA-l8e� ..."'""../lQ../�c QYI........................... ..( 0 ..... . . . H O o <br /> Tbi dd . ............................ ......... <br /> pant) C RACTOR or SU E% R or AGENT n <br /> .......�.�.-:...r.......�x....��. ................................. - <br /> ADDRESS .................................................................................. ......... <br /> 1111 I, ' ADDRESS <br /> ...................... a..Y.. .....�................................. <br /> ADDRESS . ................................................................................ ......... � �� <br /> 3�J ADDRESS <br /> i <br /> ................... ............................................................. . . . . . . <br /> PHONE . . . . . ....................................................................... ......... •� <br /> PHONE <br /> PLUMBER . ................................................................................ ......... <br /> WELL DRILLER <br /> ................................................................................ .O <br /> ADDRESS ................................................................................ ......... <br /> ........... . <br /> ADDRESS 0 <br /> PHONE .. . . . . . ......... ......... o—'.P.H.O..N.E......... . ................... ............ ....... ...... . < <br /> DESCRIPTION o a <br /> 4. Sanitary Facilities: <br /> 1. Work: o2. New Building Details No. Bathrooms ..��, i M <br /> New Building Type of Construction: No. Bedrooms .......... <br /> 0 <br /> Addition Se tic Tank Size Gals. .......... $ <br /> .......... .......... 1`at.+aaa ..................... P K <br /> Sanitary y < '� <br /> Size ........ f;. ft. x ...1. ... ft. i <br /> Filling/Grading ......,,•• Height...d. 'r. Stories ............. 4a. Absorption Field Site: i i <br /> Moving <br /> .......... Area ........................................... Soil Type .......................... <br /> . ..... <br /> Mobile Home Slope .......................... 'r <br /> .......... ....... <br /> .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .......................... ........ <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> . ........ <br /> Subdivision Seepage Trench , ,,,,,,,, ;C'n <br /> g..�.fs. <br /> Privy <br /> Camping Unit ,,,,,..... . ...,,•.. <br /> ---------------------------------------------- — ed Seepage Bed ....... Q <br /> Location of proposed structures and existing structures, well, sewage systems, roads, et---c., should be sketchin Fig A. Includ 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 highway inter- G��.J a <br /> section, show the intersecting highways and the setbacks required along <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. them and at the intersection. CLEARLY LABEL EXIS ING------------------------------------- <br /> 5 <br /> H: <br /> —_—__—__— _- <br /> 5. Lot Size: Fig. A. 6. Location:_ /� J :� <br /> ...l.fJ.Q...... ft. x .�/. It ..... ft. — ......1.(.5 ....... sq.ft. ...........................IV.e..�.(.lo.&.....A6 Scc. <br /> .. <br /> rr I ro+ �81 <br /> �-aPiL S r>d� ' � n <br /> �r ePoseQ 0 0 <br /> of ('V s <br /> o �J, <br /> I ? o <br /> ,J <br /> D <br /> HJµse- 9 � <br /> M 0 1-M W W Z <br /> a - f <br /> a' <br /> 0 2 c N <br /> a 'a <br /> Z Co > vm <br /> o � a ? M <br /> 04Y m <br /> _ c u .c��............. . �'i— �_ m <br />