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/c 4�� <br /> Burnett County Office of Zoning Administrator v 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and to ated as '� o "' <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lind Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the Statelof Wi consin._C 3 a <br /> ..., ............ .. .... ...... ........................ .. ... . <br /> OWNER (please print) CONTRA UR R ENT 3 a <br /> ADDRESS ADDRESS �� 1 <br /> � .a ... �, , ...........�,�. s ...... ....... . ....4........... <br /> ................................................. ........... .Gh <br /> ADDRESS ADDR S <br /> .: . .r. . ..........464...4.... .... ....... s� <br /> PHONE t....... ........... ..�. <br /> ���..... .FO2Y PH <br /> .. ...... 4444.. 4444 ... ... ..... ... 4444. ..... ... .. ........... <br /> PLUMBER WELL R <br /> 1.. ..'1�.r..z`- .. ........................................ <br /> ................................................... ... . <br /> ADDRE6-- ESS r o <br /> s� 0. <br /> .............. ..................................................... ...... <br /> PH E P 4444. Z 1- <br /> DESCRIPTION G�o o Pl.. <br /> F cilitie o <br /> 1. Work: o. a hr ms <br /> / 2. New Building De ••••••••• <br /> New Building ...... Ty Type f Constru�tio o. a robbbms ... .. !�! a <br /> Addition „•••,,,•• D eptlC T .......... <br /> / �..................... .......... <br /> Sanitary ,,,,,[�, Size SSU. ft. x ...7? : f ...••.•.• -10 n <br /> 4a. Absorption Field Site: c <br /> Filling/Grading ,,,,,,•... Height .... . . . .... — F : . <br /> Moving .......... Area ......... ... ...0�.'... 4444... ........... •r i <br /> Sloe ......... 90........... , o \ <br /> Mobile Home p �................. ........... . . <br /> Perc. Rate ....................... . ......... 11 <br /> Privy ..,,,..... 3. Us describe exactly 1 -Tamil N <br /> Well ........ home arage, motel, etc. Dry Well .......... <br /> Subdivision c=/ i!U l.��-/i- Seepage Trench .......... <br /> .......... ..... ................................... <br /> Camping Unit ......•... ......... . <br /> .. . Privy <br /> .... ....... . ........ . ' <br /> Seepage Bed ..... <br /> mLocation of proposed structures and existing structures well, sewage systems, roads etc.,should be sketched in Fig A. Incl de road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y inter- 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. 6 'r/I <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 00r�J 1 <br /> N r O <br /> 0 4 0 <br /> 4 <br /> /Doo Tv <br /> � - z <br /> o <br /> q <br /> < - S f <br /> m R <br /> 2 0 o n � 3 <br /> on — <br /> � o <br />