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Burnett CountyOffice of Zoning Administrator --I <br /> 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 located as 'c 0 9j <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lz nd Use - c � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wi onsin. 3 <br /> ........... Aa /7��r /> v F <br /> OWNER (Please Print) .. . .................................... _ <br /> +� CONTRACTOR or SURVEY/O�R or <br /> .. ................................................ <br /> 01 <br /> ADDRESS /� c Ap\DRESS <br /> .. .�V.fl.Q.��.,:�:..........l.l.r��.........1�� �.�) . .1, 'l. <br /> . ..A ...........� tJ L...........::�...... . r ..... <br /> ADDRESS ADDRESS <br /> � <br /> ... c..lc.:-.............................................. 9J <br /> HONE PHONE <br /> . ..................................................................................... . .......................................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS . .......................................................................................... : O <br /> o <br /> ............ . ���. . ................................................. .................. ... . <br /> . . . . ................................ ................. <br /> .................................... . C <br /> PHONE � PHONE 0� ` <br /> DESCRIPTION Z r <br /> 4. Sanitary Facilities: <br /> i. Work: 2. New Building Details No. Bathrooms ..,...... <br /> New Building TypeQf Construction: No. Bedrooms ......... <br /> Addition ...... .. .............P,fS(>G I,' Septic Tank Size Gals. ......... <br /> Sanitary .......... Size ....5�':'.�.. ft. x ..... .y.. ft. ......... <br /> Filling/Grading .,.,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving ........... <br /> Area ........................................... Soil Type .......................... . <br /> Mobile Home ........ � ' <br /> o....... . Slope ................................ r <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Fare. Rate ......................... ......... <br /> Well home, garage, motel, etc.) Dry Well ..,.,, <br /> Subdivision ... ..., ( Seepage Trench ......... <br /> ......TA.CA..P -........................ <br /> Camping Unit .......... Privy ......... <br /> .......... <br /> -------------------------------------------------- Seepage Bed-------- --- .9 <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched In Fig. A. Includ road ° <br /> er <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a high' Inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a <br /> 5. Lot Size: ------------------- --- <br /> Y o <br /> �t�c Fig. A. 6. Location: <br /> Y <br /> .../QO . ft. x ..215.. ft. — sq. ft. <br /> a <br /> m <br /> IN <br /> (b <br /> o <br /> J <br /> O_ <br /> s <br /> c 0 <br /> V <br /> _---_ —.----- t m M to Z <br /> -o A1C . "2 m � <br /> � m <br /> Z oo' . am <br /> D <br /> o , <br /> o <br /> 0 <br /> o � <br /> m <br />