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eI?c -F— <br /> Burnett County Office of Zoning Administrator do� O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> �1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m 2 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a0 <br /> O <br /> ............. ................................................................. .......... (� <br /> .......... . . . 77••�� <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> . ...... . . .................................................................... .......... f <br /> ADDRESS ADDRESS .. <br /> � b�rx........lN.l. c:...........a..`!.8. v ............................................................................... .......... c� <br /> ADDRESS ee / ADDRESS <br /> .........'V..1.! .]................................................................... . ............................................................................... .......... U <br /> PHONE <br /> PHONE <br /> ................................................................................. <br /> ................................................................................. .......... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ........ ... .................................................................... .......... .O <br /> ADDRESS ADDRESS V7 <br /> o <br /> ........................................................................................... .......NE.......................................................................... .......... —' .r . <br /> PHONE PHOz ? _ <br /> DESCRIPTION 4. Sanitary Facilities: o °r <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Cons uction: No. Bedrooms .......... -°o <br /> m <br /> AdditionJi.Ia.MG............ Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ...41.t. ft. x ...3Zft. .......... <br /> 4a. Absorption Field Site: <br /> Filling/Grading .......... Height..IT.I....... Stories 2.......... p <br /> Moving .......... Area ........................................... Soil Type ......................... .......... ---� r <br /> o <br /> Mobile Home .......... Slope ............................... .......... �\ ^ <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... Li <br /> c ) <br /> Well home, e, motel, etc.) Dry Well ..........A, <br /> Subdivision / fAn, / � Seepage Trench I p <br /> Camping Unit ,,,,,,,.,. Privy .......... r_ <br /> .................................................... Seepage Bed <br /> ------------------------------------------------- <br /> _________________ ___ i N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Inclu e road Q) <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter-� _o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING <br /> H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 5� <br /> ________________________________________ -`- <br /> 5. Lot Size: Fig. A. 6. Location: y)j <br /> ................ ft. x .............. ft. . ............................... sq.ft. ................................................................... ........... <br /> i� <br /> N aO <br /> J V <br /> ° <br /> a+ I� s <br /> / t 9��+A w i T <br /> 0 <br /> M N r- -o to% W Z <br /> dao _ F <br /> m <br /> oS. Dam <br /> Y8QlY2/ o �° : gm <br /> �� � m <br /> -j-i,,,L/1w- z)_-�,G_4/_ , � _ D . . . . . . n <br />