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Burnett County Office of Zoning Admini tratoro 0
<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
<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. 3 a iw Yfy�Y..l!
<br /> .,....R. - . z,U.......... ........ ......................... � ...e�,,� .
<br /> OWNER (Please print) j.......... CDNTRACTn ... . ....... . . . ..... ....... ........ c m
<br /> i5' R or SURVEYOR or AGENT o. m
<br /> ADDRESS s1'.....o. FF...1.�4...... .9.. ...................... pt y,...... .Cr/ 3. 4-9..............................
<br /> QNJ.P.4)..P.oltt.......... .:.... . .8Cz.5- .. ..�..� _...4- -< .r....S.y. v.
<br /> ADDRESS 1 DDRESS / " ""•
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<br /> PHONE7./ '.- ..................3..................................... ........... c
<br /> PHONE
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<br /> PLUMBER WELL DRILLER
<br /> l vim- . ....... ...„......'..Y....�.�3....... ..�. t-...........(3..o.X...3.�3..P....................... .
<br /> ADDRESS •••..•....
<br /> ADDRESS
<br /> oNs .-.a..s. . ....3. z. .......................... ...........
<br /> PHONE. ...... • • Z
<br /> DESCRIPTION
<br /> 4. Sanitary Facilities: ° o
<br /> 1. Work: 2. New Building Details No. Bathrooms ...�.....
<br /> New Building Type of Constructio�n—: / No. Bedrooms o
<br /> ..,.'... .......... `\C
<br /> Addition ,,,,,, (3.G,pc..�4,,..�...4t.J(�D4� �tLNNC Septic Tank Size Gals. ..........
<br /> SanitarySize ...., ,6... ft. x ....�.A.... ft. •••...... i
<br /> Filling/Grading ,,,,,,,,,, Height.a.S.-'. Stories ...../....... 4a. Absorption Field Site:
<br /> b
<br /> Moving .......... Area ..../.Zli.......................... Soil Type ........................ ........... i
<br /> Mobile Home Slope 70 :C
<br /> Privy ,.... .. 3. Use (describe exactly, 1 -family Perc. Rate ....................... ...........
<br /> Well home,garage, motel, etc.) Dry Well ,,,,,,,,,,
<br /> Subdivision .......... i �- �• N6�1.1g Seepage Trench ..........
<br /> P
<br /> --Camping Unit_ ••
<br /> ......... Privy ..........
<br /> --------------------------------- Seepage Bed .......... � ( °O ll;
<br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc_ should be sketched in Fig, A. Incl de road � � ��
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If
<br /> Properly is located ataEy inter-
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEAR LV LABELL EXISTING
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.
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<br /> 5. Lot Size: --
<br /> Fig. A. 6. Location:
<br /> a ...3.1. ft. t _ 99. Z4r.t sq.ft. 1:
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