Laserfiche WebLink
Burnett County Zoning Administration <br /> BURNETT COUNTY GOVERNMENT CENTER <br /> 7410 County Road K,#102 Phone(715)349-2138 <br /> Siren,Wisconsin 54872 <br /> SYSTEM EVALUATION REPORT FORM <br /> NAME W l(r'a 0/sow <br /> ADDRESS 19, La 7-71T M S' 0 <br /> FIRE #/ROADNAME -50 7 r ha.j e Abu <br /> LEGAL DESCRIPTION c-hb , otor) I n f- w r <br /> COMPUTER # D 3 P - Sa 19 <br /> - TANKS <br /> MFG WC P TYPE LO�Cre f� SIZE lOOo <br /> BAFFLE CONDITION Ge <br /> MANHOLE COVER CONDITION a r <br /> COMMENTS ownes- ..v i It eeyalRca n"w'4h0& Cove,- <br /> - <br /> over- DRAINFIELD/DRYWELL <br /> SIZE is x v TOTAL SQUARE FEET `� <br /> SYSTEM ELEVATION 9v 3 <br /> BENCHMARK <br /> - IS SYSTEM: <br /> BACKING UP INTO STRUCTURE YES/NO �o <br /> DISCHARGING TO SURFACE YES/NO �0 <br /> DISCHARGING TO GROUNDWATER OR SURFACE WATER YES/NO IVO <br /> - SOIL BORING VERIFICATION (provide on CST Soil Report) <br /> - PLOT PLAN (must provide plot plan showing location of existing septic tank, <br /> drainfield, well, lot lines and other related setbacks. <br /> - If the existing system is undersized, indicate whether or not a replacement <br /> area is available. <br /> Name ✓ m e-r .s Dan 'ej Lic. # )73'e'20 <br /> (please print) <br /> Signature /Z""' Date--6/-16 o S` <br />