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Burnett County Office of Zoning Administ ator d o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3
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<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and loc ted as < 7 -+• :J
<br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use c
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- a•� ,��
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<br /> OWNER (please print) C`07TRACTTOR/ r SURVEYOR or AGENT o.
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<br /> ADDRESS ADDRESS
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<br /> ADD ESS ADDRESS i
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<br /> PLUMBER WELL DRILLER
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<br /> ADDRESS ADDRESS
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<br /> PHONE PHONE
<br /> DESCRIPTION
<br /> 4. Sanitary Facilities: ° o ° :ia
<br /> 1. Work: No. Bathrooms
<br /> 2. New Building Details :� o :Z
<br /> New Building X Type of Construction: No. Bedrooms ... ;N
<br /> Addition ,,. „ ,,,,,,, Septic Tank Size Gals. ..C7
<br /> .... <
<br /> Sanitary Size ..� ft. x ft. ..•••..•• i
<br /> Filling/Grading ,,,,,,,,,, Height 110 (fStories ...I.......... 4a. Absorption Fi d Site-
<br /> Moving .......... Area .......516. \. Soil Type .... :NCt:...... ......... i Z o i
<br /> Mobile Home .......... Slope ............ .......... ... . ......... : 0
<br /> Priv Pere. Rate .. ...... 5.,•4. .l!.... '�
<br /> Privy .......... 3. Use (describe exactly, 1 -family
<br /> Well ., home,
<br /> etc.) Dry Weil
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<br /> Subdivision I Seepage Trench
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<br /> Camping Unit ......... Privy ....... .
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<br /> Seepage Bed
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig- A. Inclu[e road
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- I r a
<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.
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<br /> 5. Lot �iFe: f Fig. A. 6. Locatio :�/ (•�(
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