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Burnett County Office of Zoning Adminis ratora � o z <br /> 0 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 to ated as < 7 o <br /> shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L no Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wi consin. <br /> 3 m a <br /> ' — <br /> ` N 0 <br /> f <br /> ..... . s...... ... �:./ .. . .................... <br /> OWNER (please print) � - CONTRACTOR or SURV EVOR or AGENT m _ <br /> / a <br /> .........1..�.'....1..... ::1. �. ... <br /> .......`................a.................. ................................. <br /> ...................................................................... .......... <br /> � <br /> ......5- ...t.!...LJ.4:tJ. ,...l.'. A.....�I.../............... ADDRESS <br /> . ............................................................................... .......... :W <br /> ADDRESS ADDRESS <br /> .. <br /> .. /.::..1........ ...................................... . . . . ......................................................................... <br /> PHONE .......... <br /> PHONE <br /> .......................................................................................... ................................................................................. .......... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... . ............................................................................... .......... O <br /> ADDRESS — <br /> ADDRESS <br /> m � <br /> ....... .......... <br /> . ...................................................................... . ........................................................................ <br /> � o <br /> PHONE PHONE � <br /> DESCRIPTION 4. Sanitary Facilities: 0C o ° ' <br /> 1. Work: 2. New Building Details No. Bathrooms 3 <br /> New Building „•. Type of Construction: No. Bedrooms .......... �° <br /> Addition ,,,•.••.., Septic Tank Size Gals. .......... <br /> Sanitary .,........ Size ...r 1.Z'.... ft. x .....ij.i::.. ft. .......... i <br /> g <br /> ..... Height <br /> Fillip !Gradin Stories ... .. ....... <br /> % 1 4a. Absorption Field Site: i '• <br /> a ....s.:...... . .. <br /> Moving .......... Area Soil Type ............... <br /> ........................................... .......... .......... <br /> o <br /> Mobile Home .......... Slope ............................... .......... b .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ........................ .......... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ,•,•,,,.,. Seepage Trench ,.,....... p <br /> Camping Unit ,......... Privy .......... t <br /> ...........................4........................ Seepage Bed <br /> ———————————--———————————————— --------- ------ ---- <br /> --- -- AJ .be yS•' <br /> Location of proposed structures and existing:structures, well, sewage systems, roads,etc., should be sketched In Fig. A. Inclu e road l t <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highwainter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXI TING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> —__---__--__ .. � <br /> -- --- <br /> 5. Lot Size: Fig. A. 6. Location: i o <br /> ..�.t. ... ft. x .............. ft. — ............................... sq.ft. — ./e.ii t !..^ <h'..i�. ..f /. J.::. ::. ::•,�/, /� is i ?L\ <br /> it. do <br /> 1 I Fo— <br /> 1 <br /> I 2s o <br /> 7TZ, :fill, �^ <br /> I II, � <br /> fla•; _ <br /> o <br /> ;V M Corm mmz <br /> m c c m <br /> Awn <br /> os Cap d m <br /> to < ,� � c <br /> -r Z o 5 D <br /> n <br /> ^Y) r o o ate' <br /> 101— <br /> ��• 'rp � '° <br />