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C�) <br /> Burnett County Office of Zoning Administrator u ,o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o .� <br /> TO THE ZONING ADMINISTRATOR The undersigned hereby makes application for a Permit for the work described and located as '� N -^ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use $� <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> im. ...��.,..f/z.............................. .......................... c..!�z.... H <br /> OWNER please print) CONTRACTOR or SURVEYOR or AGENT a <br /> L <br /> ................. ................ <br /> liJ a <br /> ADDRESS ADDRESS <br /> ...............z(/.��..Gl(.2. ......../AI.�..+�..�.^......... <br /> ADDRESS / ADDRESS <br /> . - 3a j..Z............................................. ............................................................................................ <br /> ...... <br /> PHONE ,J/ PHONE f n <br /> PLUM WELL DRILLER <br /> y <br /> fl........ �� ...t . ............................. .......................................................................... <br /> ADDR S ADDRESS\ O .� <br /> x4��/...lrs�t,, ..... �v`6?,6/�. ............................................................................................ = <br /> o <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: '` � o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... 'p <br /> New Building ... Type of Construction: No. Bedrooms ... a <br /> Septic Tank Size Gals. <br /> Addition ..... .... ................................... ................ p l'OFf" <br /> �Sanitar ,,, Size .:k..y..... ft. x 3.z... ft. ' ••• ••• <br /> ading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ...... Area ........................................... Soil Type ........................5.R._; c//G <br /> : •o <br /> lf/ <br /> Mobile Home Slope ....................�.,y.v.G .... <br /> .......... <br /> Privy .......... 3. Use (de be exactly, 1 -family Pero. Rate ................................... . <br /> Well .. „•, hom ora motel, et .) Dry Well .......... .ck; p <br /> Subdivision .;i! F � Seepage Trench .......... q <br /> Privy iq�' <br /> __Camping Unit <br /> _________________. d ..................................___________ Seepage Bed________ yi 1C^ <br /> . ... -------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched In Fig. A. Include road l� c <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING r—:) <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------- ---------.__ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> i <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> N <br /> 7 D 0 <br /> 2q <br /> W ofo <br /> �HPafc sZ <br /> or <br /> N f <br /> �. � <. 0a: m <br /> Z o o D n <br /> on n 77 <br /> es, o <br /> 3 <br /> Fri <br /> C .y ; 0 <br /> Signat f Owner o.. Agent Date — <br /> X 37 <br /> m <br /> Remarks ......................................................................................................................................................................... m m p <br /> .......................................................................................................................................................................................�. <br /> W ' <br /> ......................................................................................................... . ................................... ..........N <br /> Inspection Date .. ��il??10. ....(.... �,•,.rc�..........................dio i o u, o o v, m <br /> p ....................................... g rtf KJ 0888880 <br /> Zoning Ad mistrator � : o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any build <br /> Ing until a permit has been issued. A permit may be revoked it misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />