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Burnett County Office of Zoning Administrator d 0 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 Lad Use m c ;w
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisc nsiinn.. 3 n
<br /> 7•... ...... ' ns..eti /ll �r � e r Gwa h G'm � n/ry N o
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<br /> OWNER (p'ea�se print) CONTRACTOR or�SURVEYOR or AGENT '
<br /> LC,..'.1.......... .?.1..t..........�.. X �.g........................ . . ...... . ...................................................................... ........ -a t�v
<br /> ADDRESS ADDRESS :� i<
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<br /> . ................................................................................. ........
<br /> ADDRESS
<br /> ADDRESS �9 '
<br /> ........................................................................................... PHONE a
<br /> PHONE
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<br /> PLUMBER WELL DRILLER
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<br /> ADDRESS ADD.. R..ES..S G1
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<br /> PHONE PHONE Z
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<br /> DESCRIPTION 4. Sanitary Facilities: � ° o ° '7
<br /> 1. Work: No.2. New Building Details 1
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<br /> New Building ....,Y Type of Construction: No. Bedrooms ...,c� :� L i
<br /> Addition ,,... ,,.. ,.,,,,,,,,, ,. , .....,,,,,,,,, ,,,,,, Septic Tank Size Gals. ..........
<br /> Sanitary .... .... Size . .X..�ft. x ..;n F.... ft. ....cr i
<br /> Filling/Grading Height............. Stories ...............
<br /> 4a. Absorption Field Site:
<br /> Moving .......... Area Soil Type .................................... '
<br /> ........................................... r
<br /> Mobile Home Slope ..........................................
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<br /> Privy ... ,,,,,, 3. Use (describe exactly, famil Perc. Rate ...................................
<br /> Well home,garage, motet, etc.) Dry Well ...... S
<br /> ...
<br /> Subdivision Seepage Trench
<br /> ......... ........ .......... ....
<br /> Camping Unit .......... L�-P.�'.. ...L4. ../..C!.G .. '* ' y
<br /> ................ 41 Priv
<br /> Bed
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<br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc-,should be sketched In Fig. A. Includ road
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a hlghwa in15—ter- a
<br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXIE TING (1, =
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