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Burnett County Office of Zoning Administrator d o / o <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 Land Use c <br /> Ordinance, Sanitation Code, andwith all ther applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a 0tiff <br /> ... . \. :. La. .............. .............. .f ,............. .............. . . .... m �_ \ <br /> a <br /> ... <br /> O lW...N.2ER. (pl/. (gase pint ........ . ....... ................ <br /> ,w (�U'(^�I CDNTRACT R or SURVEYOR or AGENT <br /> ..... ..�.S .. <br /> A RESS ADDRESS •' <br /> S �Lt......,.M...................S�37 <br /> . .............. <br /> ADD RESADDRESS <br /> ............. .................................... .... ............... .......................... ............. ................................................... <br /> PHONE PHONE <br /> �AF LJ <br /> ........ � ........................................................ WE. . /Y. .. .............................................................. <br /> PLUMBER LL DRIL <br /> ADDRESS ADDRESS 0 o O <br /> m � <br /> ........................................................................................... ............................................................................................ : o' .: <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms l o ~ <br /> New Building „ T e of Construe ion: No. Bedrooms ..�.. 0 <br /> Addition .. ., � -� ..•, .po . . Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ........ t. x .�. . ft. •"'•'••'• <br /> .. <br /> FiningiGrading ,..,,••,,, Height t ies ......'.. ... 4a. Absorption Field Site: <br /> jy rn < <br /> Moving .......... Area ...aC.f• �.1. . ... Soil Type .................................... i <br /> r <br /> 0 <br /> Mobile Home .......... SIOPe .................... ..................... ,* <br /> Privy ...... 3. Use (describe exactly, 1 family Perc. Rate ................................... i <br /> � Dry Well <br /> Well ,,,,,,,,,, h e,ga age, motel,he )Subdivision .......... Seepage Trench .......Camping Unit .......... . •�. [C [�J Privy .......... <br /> --------- ---------------- ------------- Seepage Bed---------- spy, R <br /> lJf c I <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in FIg. A. Include road � ' <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 property is located at a highway inter- �— cr <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURFS AND ADDITIONS--_ <br /> 5. Lp ize: q �n{ Fig. A. 6 Location' <br /> .. �.. ft. x ..`3_0. ft. — 9.a L..... .. sq. ft. ............... ........ .. .... ......... ............. .......... . .. . U) 1: <br /> r <br /> Cot <br /> 3 <br /> T <br /> *MOrT n(o o <br /> Or— FYI <br /> al Por <br /> ° w gy- <br /> A4, of <br /> �qL� J] fnry y Z <br /> j O CC 0c m <br /> f ¢ C <br /> /f '< c <br /> / ?�Y ON m •� D m <br /> AA P 11 t Z OO n 70 <br /> (rl,eo , <br /> M <br /> ,m, <br />