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Burnett County Office of Zoning Administirg for 3 0 <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT m C <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '" <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and C <br /> regulations of the State of Wisconsin, 6, <br /> Ike Walton Lodge = O <br /> .......................................................... <br /> w <br /> ••••••••• CONTRACTOR or SURVEYOR or AGENT �T� <br /> OYJNER (please Drint} :r <br /> Star Rt. ....... ADDRESS............. <br /> DDRESS .. <br /> ....................... ....................................... ..... d W <br /> ...... <br /> ADDRESS � 'p• (D <br /> Danbury, WI 5830 J' <br /> .............. .................. X <br /> .................... ADORE <br /> ^^^••• SS X <br /> ADDRESS 1 ' <br /> 715-866-71011. <br /> ...... ........................................... .......�� iSU ` o <br /> ................................. <br /> PHONE R <br /> PHONE �Jt O <br /> DonaldDaniels ........................................................................ 4 <br /> ................................................................................ O <br /> PLUMBER WELL DRILLER 'v <br /> Box W Siren, WI 5 72 - <br /> ................. .......................................................... ADDRESS. .......................................................,....... O <br /> AOORESS � <br /> ....................................... ........ . <br /> PHONE PHONE N r <br /> DESCRIPTION 4. Sanitary Facilities: ° <br /> No.Bathrooms •••••. `� <br /> 0 <br /> Work: 2. New Building Details No.Bedrooms <br /> Construct-ion. <br /> U\ W <br /> New Building Type of Ction: v <br /> Addition ..................... <br /> Septic Tank Size Gals. ...,..... : <br /> Sanitary x .............. <br /> ••••• Size ft. x .............. ft. <br /> •'••• 4a. Absorption Field Site: ' <br /> Filling/Grading .......... Height............. Stories .............. � o <br /> Area Soil Type .............. <br /> Moving ......4.............................. <br /> Slope <br /> Mobile Home <br /> 3. Use (describe exactly,-1 -family Perc. Rate .. ... C, i <br /> a, <br /> Privy .......... Dry Well m i <br /> Well home,garage,motel,etc.) z <br /> Seepage Trench ......... ,; o i 1 i,_0 <br /> Subdlvislon ....... .......................................I............ Privy <br /> Camping Unit : <br /> `, a.......... .................................................... Seepage Bed <br /> _________ ---------------------------------- --- �a c <br /> Location of proposed structures and existing structures,well, G <br /> sewage systems, roads,etc.,should be sketched in ig. A. 1 <br /> ack from all bodies of water. If property is located at <br /> Include road setback,side and back yard dimension and location and setb <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the inters lion. o:U,'; <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ———————————— <br /> --------------------------------------- --- --- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. .................. sq,ft. <br /> t <br /> o N- <br /> �c�ts �W <br /> o O 3 sp <br /> El <br /> -7' o <br /> C3 <br /> See State approved plans 0 QJ � <br /> . 1 D <br /> z <br /> o • <br /> A <br /> �I 7 <br /> m N n S. S.U7 <br /> w m <br /> m 0, `c aw EL aaMI <br /> < N '0 40 � <br /> 8 y _ <br /> O 'G a . <br /> �'� 0a : <br />