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Burnett County Office of Zoning Administrator C/) <br />C --I o <br />APKICATI.ON FOR SANITARY — LAND USE — BUILDING PERMIT DN <br />rtKS <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c {f� <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br />............i�............................................................................................................................... O <br />OVINE (please grin CONTRACTOR or SURVEYOR or AGENT � <br />CL : rt <br />i .. . {..........,••1•. ..... .......IV .... ................................................................................................................ Q' ' IJ <br />ADDRESS ADDRESS <br />ADDRESS ADDRESS ' <br />........................................................................................................ {�+ <br />PHONE PHONE <br />........................................................................................ <br />PLUMBER WELL DRILLER �.. <br />.....D........................................................................................AD...D........RESS.............................................................................. <br />ADRESS � � i, <br />h O< <br />....................................................................................................................................................................................... O• r+ <br />PHONE PHONE z y 0 <br />DESCRIPTION 4. Sanitary Facilities: f g 0 <br />1. Work:2. New Building Details No. Bathrooms o <br />New Building Type of, r truction, No. Bedrooms P.:(� CD <br />o <br />Addition �e(�?,{!..�/.�J......Q..1.... ............ e Gals. .;. <br />Septic Tank Siz <br />NkSanitary '. Size ........... ft. x ...... ft. <br />Filling .......... Height ............. Stories ............... 4a. Absorption Field Site: �. <br />Moving .......... Area.......................................... Soil Type .................................... } �; o <br />GradingSlope ......................................... <br />Mobile Home .......... 3. Use (describe exactly 1 -"family Perc. Rate .................................. <br />Privy home, garage, motel, etc. Dry Well <br />Well Seepage Trench .......... N, <br />Subdivision .......... Privy .......... t <br />.......................................... <br />Seepage Bed .......... <br />--------------------------------------------------------------------- w <br />Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road C <br />j setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- \ A Q <br />jj 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. <br />5. Ljqize: Fig. A. 6. Location: <br />.. ft. x .w.G�.�.�.. ft. — .... ...`�Cr rs....... sq. ft.(� <br />............................................................................. <br />P <br />Cn <br />ID <br />r+ <br />N p <br />O 7 <br />7 <br />TSI. <br />N <br />h C� <br />M � N <br />3 <br />7-T CD <br />If <br />CD <br />0 <br />( <br />�o cn(n Do <br />CD <br />c m <br />0 <'"d2E•l, <br />T. NQQ-G —rr 0- <br />-0 <br />-a cn < C <br />rF Q y y < CL7 M <br />o =� <br />to _ <br />o <br />o � <br />. <br />