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'w!11 C-ti--7-, , <br /> r-/ ij <br /> Burnett County Office of Zoning Administrator � o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT Iv 3 - �: <br /> h ° 5 ; <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 m ) �� <br /> Drdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o- cC` <br /> / rt v 0 <br /> DWNE (lease print) CONTRACTOR or SURVEYOR or AGENT m <br /> co <br /> / lu dt-r, J ,4t/ G c 1.' 35 -a-.ADDRRES ADDRESS <br /> 110 irt..('('`l'{ Pki /L,f F'l 3� p <br /> ADDRESS ADDRESS <br /> {(1 <br /> PHONE PHONE �\ vJ <br /> Nk <br /> PLUMBER WELL DRILLER <br /> 0. <br /> ADDRESS ADDRESS o o <br /> r. < <br /> o' , <br /> PHONE PHONE Z y r <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> No. Bathrooms ° <br /> 1. Work: 2. New Building Details <br /> Bedrooms o <br /> New Building X Type of onstruction: No. \, co <br /> Addition ee9 AI. Septic Tank Size Gals. �\�\ <br /> Sanitary Size iq T'. ft. x C ft. ' <br /> Filling Height ii Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate (•,, <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well / -,, , e. Seepage Trench <br /> Subdivision �rPrivy I <br /> Seepage Bed '� <br /> ccn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road Stij 6 'tea <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- UN/ °- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: /.) Fig. A. 6. Location: N <br /> ft. x ft. — ..... ..r3..7.....Y.F'C sq.ft. (rr f / ti.7 r-'(4-p Q:-i3,v2 S/i"* n Ch <br /> t 6 L,%1-/ c f- S it; c ',u i ' <br /> v` (6 <br /> 1') <br /> N o <br /> 1, O 7 <br /> r 2 <br /> s 0 <br /> N <br /> I —I <br /> S <br /> n/•6_t r , A —. <br /> �4)e m N <br /> 7/ Z <br /> 0 <br /> m <br /> S1 m <br /> ti m <br /> a <br /> m <br /> J N. <br /> % Do cnr7 * � wZ <br /> { cD C al — cD N C CD <br /> _ ° <br /> / a). N Q 0_< — '-i - <br /> -° cn < C a' 5• 0 -0 <br /> / 7c r" y - OZ 05 `D . : m 70 <br /> i 5' g <br /> v,o —I <br />