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Burnett County' _t Office of Zoning Administrator E' <br /> APPLII�,ATF�N FOR SANITARY — LAND USE — BUILDING PERMIT v 3. <br /> TO THE ZONING ADMINISTRATOR: The undersignetl hereby makes application for a Permit for the work tleults <br /> retl and located as ~ o <br /> shown herein. The undersigned egrees.that oll,work shall be done In accerdanco with the requirements of the Burnett County Land Use m <br /> Ordinance. Sanitation Cotle,and with all/other applicable County Ordinances es andthelaws and regulations of the Sof Wisconsin. is <br /> State <br /> is <br /> 3 <br /> Y <br /> OWNER Ipv/l[e1a7seprinCONTRAC®R-r RVEVOR or ACaE /y' ps C\::Bz <br /> ADDRESS .....SS.rr�.../..�./... .:/. .!l........ ADDRESS...�... ..... ./a/.x.' .. .. / <br /> S .. ..V............. .................... . ...... ...... ..... ........ . ..................................... �� <br /> ��/�1.. ... ............ . . .. r� <br /> ADDRESS ADDRESS �� ?I <br /> . .St.� ..u...... -.... . <br /> PHONE . PHONEIn <br /> PLUMBER ��jj,� s WELL DRILLER <br /> ..... ....... .' ..y/./...treat.9,— ....:s(.�.. .. ... .r. ..... <br /> Z,5flEH........ ....... ...... . ................ <br /> :� q o <br /> 1 VVV <br /> . .../........ � .../i<..'. ..r ......`f�.��.1. ........... '� o <br /> PLO 2. New Building DetalioNE........................4. Sanitary <br /> BedroomsFBathrooms ........... ... AAs a ,t <br /> DESCRIPTION <br /> 1. Work: y g ._ ._..__ S ile .............. ft. x .-............ f.. Septic Tank Size Gals. G /n S <br /> New Building Type of Construction: n j <br /> AdditionH [ j <br /> F�ng X.... Height............. Stories ............... 4a. Abs—, <br /> Moving .......... Area .. Soil TYPe ................................... <br /> .................... .............. <br /> Grading .......... Slope ......... ...................... <br /> Mobile Home ......._. 3. Use (describe exactly, 1 -family Pere. Rate ................................... ti <br /> Privy „ home,garage, motel,etc,l Dry Well .......... <br /> ........ <br /> Well Seepage Trench <br /> .........� 1 R <br /> SubdivisionPrivy : ` t <br /> __ __________________________ ____ _________ __ _ Se--- Bed .,,.,,.._ <br /> Locmbn of _ <br /> prnd Bac structures and existing l cation an setback from <br /> m all godin,ds n at should be sketched it Fig, a highway <br /> roar Q <br /> setback, sitle and Lack yard dimension and location and setback (rpm atl bodies of water. 11 Property is located at a highway imer <br /> section, show it , inteapctiog highways antl the satbecks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> iSTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ;t--------------------------------------------------- ------------------- <br /> 5. <br /> _ ___ _ _5. Lot Size: 1p qq Fig. A. 6. Location: yy, <br /> ........._...., ft. x ........_.... ft — .Y" .(Ll�.r� s9.ft. .......a..[L./. /e,�....r/...c.........V. ..Q:.n CO. AA ? < <br /> F <br /> N <br /> 0 <br /> 71 <br /> x a <br /> 3� :\ <br /> 3ctcres 3 <br /> j- Ilr J e� Is <br /> 0 <br /> a <br /> T <br /> �I <br /> is <br /> is <br /> A o'n'a< <br /> Is <br /> N O T, <br /> F R <br /> o doder uI <br /> 3 <br /> r' .�� ................... ....�J--.. 5.-..^�f f c o <br /> x <br /> n <br /> G <br /> Signa of Owner or Agent Dare ° O <br /> X i Or <br /> . r i n <br /> `•Remarks ... ._._...... ......................: is i s :' C <br /> Or <br /> .............._.......... ..............................................._....... ............................................................ _.................................. <br /> _ _ .. <br /> - ..................._._............. . ............. - <br /> .................................................................. O <br /> ..................Q........ . ...�.... .... ... ................ <br /> Inspection Date ....................................... .Q-j'.;l,.o( .tir41E.'-..LJ�.C.a✓ . ' o o o o boo p n <br /> Zoning Adm?fiisiratar' 0 0 0 o 0 0 <br />'NOTE-A preliminary rile inspection must be mete and site approval (panted on all Stnieluies involving si kith, facllitins <br /> before construction can begin. In the case of sewerage d"Pusel systems, a d-PY of the percoleti In test must be attached to <br /> this application before a permit will Be issued. Do not purchase or install a septic tank, do ad, plumbing or start any Build- <br /> ing until a"Ptr nit has been issued. A permit may be invoked If rn isreprevnuatipn of eny,of theinfo,motion convoyed horn- <br /> Itiith is found to exiv. Changes in plans or specifications shall not be marl, without approval of.the Zonipg,Adnt inisb oto, <br /> IISEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />