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Burnett County Office of Zoning Administrator d -- 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 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 < H 0
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m c
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin o.
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m i
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<br /> ADDRESS ADDRESS
<br /> 11Q. .�.p...a..r '.... ........s'a R6 s
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<br /> ADDRESS ADDRESS �
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<br /> PHONE PHONE 1 EC
<br /> !3..... ? .. 1.n..s.............................................. .................................................................................. ......... VQ
<br /> PLUMBER WELL DRILLER
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<br /> ADDRESS ADDRESS
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<br /> PHONE � . .......... .......................................... � •.:
<br /> PHONE Z h
<br /> DESCRIPTIONr
<br /> 4. Sanitary Facilities: P o °
<br /> 1. Work: 2. New Building Details No. Bathrooms . ....... :P
<br /> New BuildingNo. Bedrooms ......... z
<br /> Type of Construc
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<br /> Addition ,,.,.,,,,• ,,,,,,,,,�Q�, c�,/ (a�',,,.••••„••,. Septic Tank Size Gals. ...1..... V
<br /> Sanitary Size ft. x ft. •......•. '
<br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving Soil Type ...................
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<br /> Mobile Home .......... Slope ................................ ......... o o � ..
<br /> Privy
<br /> .......... 3. Use (describe exactly, Parc. Rate ......................... .........
<br /> , 1 -family
<br /> Well .......... home,garage, motel, etc.) Dry Well ......... '—O E
<br /> Subdivision .......... .................................................... Seepage Trench ......... .;
<br /> Camping Unit ,,,,,,,,,, Privy .........
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<br /> Bed . .......
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Lig. A. Inclu e road
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<br /> setback, side and back Yard dimension and location and setback from all bodies of water_ If property is located at a in
<br /> ighwa rotor- —d °-
<br /> section, show the Intersecting highways and the setbacks required along them and at the, intersection_ CLEARLY LABEL EXI TING t u
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O i o
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<br /> 5. Lot Size:
<br /> Fig. A. 6. Location:
<br /> ................ ft. x .............. ft. — ............................... sq. ft.
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