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Burnett County Office of Zoning Administrator �' ✓ o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 63. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and �2 M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 7 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws no 3 <br /> regulations of the State of Wisconsin. » ' <br /> �..... .....n-�Z7 :.Rt:c�r.Frd..(Z1.9.5!gS.... -T.�aJ.......1�a.u...�.k..S............... ...... <br /> ........ .... <br /> OWNER Iplease print) CONTRACTOR or SURVEYOR or AGENT ; <br /> S wee _ \ <br /> ...l. .iia.......�.q.�:!r.... ......�.:.........t.................. .............l..e.t....(........................................................ ...... d :� � <br /> ADDRESS ADDRESS <br /> QP.S °.�.n �..sem......Zocvrti ................................bs� ..LU........................Sz/�9 . ...... IA `� <br /> ADDRESS // ADDRESS ' uQ <br /> PHO .� ... ..V... �.... .... ...................... .PHONE.... �.�.. ..�. � <br /> d�... . ............................. <br /> . ...... t , <br /> aCc�rt..s ...... <br /> PLrt..sUMBER.. .....t . . ....................................... ............RILLER yU. ......................................... <br /> ....... ; ° <br /> WELL D <br /> �i41.P.. ri..... .!............................ ..................................................................................... ...... ' <br /> 0 <br /> ADDRESS ADDRESS <br /> m <br /> .. ss <br /> - vb ................................................ . ........................................................................... ...... o <br /> PHONE PHONE......... Z N r (� <br /> DESCRIPTION 4. Sanitary Facilities: ° o » , <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> c <br /> New Building No. Bedrooms <br /> ....... Type of Construction: .. """' R S <br /> X Septic Tank Size Gals. ...... <br /> Addition .... . . .................................................... < <br /> Sanitary .. ....... Size .............. ft. x .............. ft. .. ....... <br /> FIIlingf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ............................ ....... <br /> .......... Area ........................................... o <br /> Mobile Home Slope .................................. ....... <br /> .......... <br /> Privy .......•.. 3. Use (describe exactly,'1 -family Perc. Rate ........................... ....... o <br /> Well .......... home,garage, motel,etc.) Dry Well .. ....... m <br /> Seepage Trench Z <br /> Subdivision .......... .. ....... o ; <br /> .................................................... n ` <br /> Camping Unit .......... Privy .. ....... Y <br /> .................................................... Seepage Bed i <br /> ------------------------------------------------------------------- -- .,.�- E rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. : c <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 intersection. �`—, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. —_ :� <br /> ___________________________________________________________________ i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. <br /> N O <br /> Ex <br /> . ) Z <br /> ri a <br /> d <br /> _ <br /> Prcvos-°d <br /> drtron s i <br /> � <br /> � iud00mmm <br /> n �o < � = n =. <br />