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Burnett County Office of Zoning Administrator M o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e ;O <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ^ ?a <br /> h � d Q <br /> 1�.a .. ... �z'. .1..� ./�2. .4.H.............................. .................... . ....... ........ .... ... .... . .... ............................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT n <br /> �.3.3.1.a CRn n!oev �ts - <br /> u�..r.2..... ............................................................................................ d <br /> ADDRESS ADDRESSH. ' <br /> .&M.y...........A...... �.-:. :... -o � <br /> ADDRESS ADDRESS <br /> fictive. (9/Qn.?-L137— .3y .. <br /> .................. ............................................................................................ <br /> PHONE PHONE <br /> :Ttl <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .AD......DRES..................................................................................... � <br /> ADDRESS S n O <br /> ........................................................................................... ............................................................................................ o' :j <br /> PHONE PHONE Z C <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••'•� � o <br /> New Building Type of Cons ruction: No. Bedrooms .......... 'o <br /> Addition „fj(�e,�.d.,. t;;A-/rl,,;e........ Septic Tank Size Gals. .. ....... <br /> Sanitary <br /> .......... / ,/.... ft. <br /> Filling/Grading ......•••• Height..$.f.T... Stories ............ 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> ..................................... <br /> Mobile Home g x�y Po Pc A Rdd Slope .......................................... M <br /> Privy .......... 3. Use (describe exactly, 1 .-family Perc. Rate ............... ............. E <br /> Well home,garage, motel,etca Dry Well <br /> Subdivision .......... e.e Seepage Trench .......... <br /> Camping Unit .......... ................... Privy .......... N <br /> ... ............................. <br /> Seepage Bed .......... <br /> -------------------------------------------------------------- ---- '� N <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Yri.�l e <br /> T <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- v �- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: ft x Fig. A. 6. Location: i(a <br /> .............................................................................. Ul V <br /> i3d Ne �.o K '�z 6, €3 <br /> �� e ccl <br /> N <br /> s <br /> 9N O <br /> .tr <br /> — ANt �� <br /> lc8 or l �o 114tc'l' GYM/s7 <br /> �Sft� WSGYee Al o <br /> V gcre4N/ /y <br /> Ff �} 71 <br /> X f )G /' !' � �. S /dY�¢/ <br /> �j <br /> CS /1'i / m <br /> lt\ !y (� <br /> �fi'/1•/y' / / � <br /> Lai <br /> f'V <br /> LL a <br /> CA ry f I. pip <br /> IN Cr <b o Z" � m 5 <br /> o m <br /> o N1-y/ 14, Z n <br /> _ -- D m <br />