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,z <br /> Burnett County Office of Zoning Administrator in g�g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the equirements of the <br /> Burnett County Land Use Ordinance, Sanitation code, and with II o(her applicable County Ordinance and the laws -no 3 `a <br /> regulation ofthe State ofWisconsin. /� /r n ' _ r, 3 <br /> r ti CSGY� <br /> .:.... ... ............................ . .. �. � �..... �( ........C ....... .................. ..... <br /> OWNER (please print) 4DNTRAGTDR or SURVEYOR or AGENT <br /> ADDR S ADDRESS .°1. <br /> .... ..................... <br /> 0. .................................................. ........ .. ............................................................................ <br /> ADDRESS ADDRESS.. .... <br /> ........S.Y..(.�1......1............................................................. ............................................................................................ <br /> PHON PHONE : _ <br /> .. .Q J <br /> . ........................................... . .......... ..................................................................................... ...... <br /> PLUM ER . WELL DRILLER <br /> 10 <br /> ....... . ................................................... ..................................................................................... . n :� <br /> ADDRESS ADDRESS <br /> 0, <_ <br /> ............. . . . ............................................. ...... ... <br /> . .. ... ..... ..................................................................................... ...... O <br /> PHONE .. PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms 'O ' <br /> 2. New Building Details --- -• ••• o ' <br /> Now awmmg Type of C�'o!nstra n: No. Bedrooms ... ...... <br /> Addition ._._...... ,,,,,,,'"E„g,�,„-S„ Septic Tank Size Gals. <br /> ........t ... . <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ............................. ...... r <br /> o <br /> MODIIa Home .......... Slope ................................... ...... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................ ...... m <br /> Well .......... home,garage, motel, etc.) y M <br /> Dr Well ... ...... m <br /> Subdivision .,.,...... Seepage Trenchz <br /> Camping Unit <br /> .................................................... Privy <br /> .......... .................................................... <br /> Seepage Bed tc iP-- <br /> (eN <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig A. � <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersects n. ^ _,y `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - •Y—I o <br /> _----_ _ -------------------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 0 O <br /> UJ <br /> O <br /> USo <br /> i 7 <br /> 9 <br /> d <br /> J <br /> N <br /> hT' <br /> r^a < J J 0 EL-L a RI <br /> v o< d cy j 3 <br /> oino � � � D - 1 <br /> utJ rn a ' <br /> � ` o m <br /> � � c <br />