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ice'- 47 7 c ti' y <br /> Burnett County Office of Zoning Administrator 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 m <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsi n. 3 a IFjIY\N',I <br /> ........... .... . ...t1.. . ../. ....C.... . T.al `.G..... 1G H <br /> OWNER (please print) %��� 7 CD1slTRACTORRVEYOR or AGENT a A <br /> ......... ............... G:......... 1.LJ.T..L.... ...... .b=.!:.d'............................ ......... <br /> ADDRESS Ss�Ua� AD RESS <br /> ADDRESS ADDRESS <br /> �zl s.-...-.... . .y.-... ....................... ......... 9 �, <br /> PHONE PHONE I it <br /> ................................................. <br /> ..53.7....... l.& C3 <br /> PLUMBER - WELL DRILLER ; <br /> N <br /> ADDRESS ADDRESS m (�. <br /> n 0 o <br /> ........................................................................................... . . . . ......................................................................... ......... I 1 <br /> PHONE PHONE Z N E- <br /> DESCRIPTION 4. Sanitary Facilities: oo o <br /> 1. Work: No. Bathrooms v : '� <br /> 2. New Building Details ••••"••'• d: o <br /> No. Bedrooms 'o <br /> New Building .... Ty of Construction: " """• <br /> Addition •,,,, „•, ,,,, /}•/�„(};<j,E Septic Tank Size Gals. 4444...... - E <br /> qn < <br /> Sanitary Size ..a.':. .... ft. x <br /> Filling/Grading ......,,,, Height............. Stories ...ii .. ...... 4a. Absorption Field Site: I> <br /> MovingArea ...............44............44............ Soil Type ..........................4....4 <br /> Mobile Home .......... Slope ..............4........................... <br /> Privy .....,,,,, 3. Use (describe exactly, 1 -family Perc. Rate .....................4............. <br /> Well home,garage, motel, etc.) Dry Well ....... <br /> Subdivision ...44..... Seepage Trench ....... I7 ' <br /> Camping Unit .......... .................................................... Privy ...... I <br /> .. . ............................................... Seepage Bed <br /> ......— Iv <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Inclu e road �� C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- o. <br /> .Z!F <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXI TING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _______________ <br /> 5. LoPile: /_/� Fig. A. 6. Location: <br /> .. ... ft. x .�7C�� ft. — ............................... sq.ft. ..........................'......�................................. ......... � <br /> I <br /> �A o <br /> 0 0 0 <br /> I j <br /> f <br /> 7 loo' 1 ?Ito, <br /> F <br /> i <br /> \ � a <br /> Ny N r N [p Z <br /> G oQp- m_ <br /> / N f <br /> v� <br /> Z oo' m m <br /> n <br /> L it o aS � <br /> fir <br /> m <br /> L' o <br />