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�^C Z'-7� <br /> Burnett County Office of Zoning Administrator d ' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as \1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m e :!ry <br /> Ordinance, Sanitation Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsin. 3 �- yl�Jl <br /> m <br /> Dean J. Nelson N _ � Oj <br /> ..................................................................... ......... . . . ............................................ ......... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m i m <br /> n <br /> �3 <br /> ........................................................................................... <br /> .A..D....DRESS........................................................................... ......... <br /> 'n w <br /> ADDRESS <br /> Grantsburg, WI 54840 Mr : m <br /> ...................................................... ... <br /> .. ........ .. <br /> ........ AD.....D.RES.. .... .................................................................... ......... <br /> �:� <br /> ADDRESS S p' <br /> 715-463-2889 a ' 4 <br /> ................................................................................ . - ...................................................................... ......... <br /> PHONE PHO......NNEE R <br /> Donald Daniels " m <br /> ...................................................................... <br /> PLUMBER WELL DRILLER ' 0 <br /> Box W Siren, WI 54872cs <br /> ........................................... . ............................................................................ ......... o <br /> ADDfl ESS ADD..... RESS O <br /> P..H...O..N..E..... . . .. . .. . ... . ............... . .... . .. . . .................. .. .. ... . . .. <br /> o °715-463-2333 <br /> . ............. ..... .... . ... ...... .. ..... .P.H.O .. .... . .... ..... .... ..... ...... .. .... < <br /> - <br /> Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms ...1..... v <br /> 2. New Building Details <br /> o <br /> New Building .... Type of Construction: No. Bedrooms ...3.... ;-Q� : t <br /> m t <br /> Addition .......... ...Mo.fail.e..home....................... Septic Tank Size Gals. 000' <br /> Sanitary ,,,,X,,,, Size .............. ft. x ft. ........ <br /> I'Mingb Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .......................... ......... <br /> Mobile Home .......... Slope ................................ ... ..... _ C o <br /> Priv Perc. Rate ............................3..... <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Well .......... home,garage, motel, etc.) Dry Well .......... - <br /> Subdivision Seepage Trench .......... z <br /> .......... ......................I.................. .......... I <br /> Camping Unit ...... Privy .......... :o <br /> .................................................... <br /> Seepage Bed .x....... :NI, <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc.,should be sketched in Fig A- I1ce road c:.ea a <br /> CT <br /> setback, side and back yard dimension and location and setback from all bodies of water- If property is located at a highwa inter- [(•F <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXI TING / i y p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. U 5' <br /> ---------------------__—__----__—_-----__---__—__-----_—._._-- ------ —__ <br /> 5. Lot Size: Fig. A. 6. Location: :o : E <br /> ................ ft. x .............. ft. . ............................... sq. ft. .................................................................... .......... ro <br /> m <br /> O <br /> m rn <br /> 2 <br /> O r O <br /> 3 W <br /> C) <br /> ro N <br /> See Attached 0 o <br /> ro <br /> a <br /> o <br /> rj z <br /> w <br /> A T : Z <br /> io <br /> z <br /> 0 <br /> D\ � <br /> O+ ca <br /> In m <br /> M N r 9 W Z <br /> oD n m <br /> z 0 0 77 <br /> O <br /> 1/Xl7ilar (I�12r I/� �0 2 7 _ X �� o En <br />