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Burnett County Office of Zoning Administrator a o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes app:ication for a Permit for the work described and Inc ited as < <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Barnett County La A 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 M - O <br /> .................................................................................... .................................................................................. ......... <br /> OWNER (please rind CONTRACTOR or SURVEYOR or AGENT a <br /> .. ...................... ...................................... a <br /> ADDRESS....... ..... . ................................................................................ ......... � <br /> ADDRESS ' <br /> Sieh'ri.... . .3 .- >> ............................. �( o, <br /> ADDRESS ............ ..................................................................... ......... 7 � <br /> ADDRESS ;J�/ <br /> 7rS. -.los3, a386- <br /> PHONE <br /> ........ <br /> PLUMBER WELL DRILLER <br /> ...................... .. `�83} <br /> .. ...................... . ...................................... <br /> ADDRESS .......................................... ......... O :\ <br /> ADDRESS <br /> ....... ............................................................ . ............................................................................... ......... <br /> PHONE P <br /> .. <br /> HONE <br /> DESCRIPTION o o CCC <br /> 4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms ;� 'O <br /> 2. New Building Details ' <br /> New Building ,...,,,,.. 7 No. Bedrooms ... z <br /> ype of Construction: rr <br /> Addition ..... Septic Tank Size Gals, A .....7.. J D <br /> Sanitary .. . .... Size .............. ft. x ft. �O <br /> .............. ,VJ <br /> F i l l i ng f G rad i ng .,.,.,,... Height............. Stories ............... 4a. Absorption Field Site: ( ;�? <br /> Moving ,......... Area ............... Soil Type .......................... ......... <br /> r <br /> 0 <br /> Mobile Home .......... Slope ................................ .. ...... i .+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ ....... <br /> Well home, garage, motel, etc.). Dry Well ......... <br /> Subdivision <br /> Seepage Trench <br /> .�%...6... ........... moi...... � <br /> Camping UnitI.... Privy .. <br /> �F"K�... ... <br /> -- ------ ---- - --- . .. ----Seepage Bed--------- --------------------------- <br /> Location of proposed structures ano existing smwtures, we sewage systems goads etc, should b sk ched uh Fi 7 P. Inc,u e road <br /> setback, side and back yard dimension and Wcatiion and setback from all bodies of carter If iropenly s 'ocated at a high era inter <br /> - <br /> Section, Show the intersectnq hlphways and the setbacks required along them and at the ntersecti<n CI_FARL Y LABEL EXISTING t i <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0 <br /> 5. Lot Size: -� <br /> Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ._..................._....... sq. ft. ; A` <br /> ............................................................................... <br /> d_ N <br /> 1 N � o <br /> o � <br /> ifNI <br /> 0 3 v <br /> O <br /> "ll T <br /> m <br /> Z <br /> O <br /> X to Z ` <br /> m <br /> orid < 6 <br /> �. m `- m <br /> 0 00 an7J <br /> A - <br /> 0 1 <br /> O <br /> O � <br />