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c9?^, Gd' <br /> Burnett County Office of Zoning Administri for �' 3 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. = m <br /> Dan Searlesg A <br /> ...................................................................... . . . ................................................................. ...... <br /> OWNER (plena print) CONTRACTOR or SURVEYOR or AGENT <br /> Hertel, WI 54845 <br /> w..... ..................................................................................... <br /> AODRESs ADDRESS I i N .� <br /> . . . ................................................................................ .AD................................................................................... ....... � A <br /> ADDRESS DRESS <br /> 715-349-5491 _ 0c <br /> ........................................................................................... .................................................................................... ....... <br /> PHONE PHONE <br /> Donald Daniels <br /> .. . ...... ............................................................................... . . . ......R'*i'L ................................................................. ....... <br /> Z0 <br /> PLUMBER WELL DRILLER <br /> Siren, WI 54872o <br /> ............................................................................... ....... <br /> ADDRESS ADDRESSn o <br /> 7..15-3!!9,-5533.......................................................... ». <br /> ...................................................Y............................... ....... o <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> No. Bathrooms <br /> 1. Work: 2. New BuildingDetails " """' o ' <br /> New Building No. Bedrooms <br /> .......... Type of Construction: " """' ' <br /> Addition <br /> Septic Tank Size Gals. - <br /> .......... .................................................... ..... <br /> Sanitary ...JC..... Size .............. ft. x .............. ft. . ........ <br /> Filling/Grading „•,,,.... Height............. Stories ............... 4a. Absorption Field Site: .. ... ' L <br /> Moving .......... Area ......................................... Soil Type ........................... <br /> Mobile HomeSlope ................................. ..Ola. K <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .......................... ..5.... <br /> Well .......... home,garage, motel,etc.) Dry Well . ........ <br /> o <br /> Seepage Trench Z <br /> Subdivision ...s.ingle...family...home....... . ........ <br /> .......... <br /> Camping Unit <br /> .......... Privy . .... ... __ p <br /> .................................................... <br /> Seepage Bed . ..x.... ; t <br /> -------- — -------------- ———— ------------ -- ., ?s <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. j C <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is loca ed at _� Cr <br /> a highway intersection, show the intersectio highways and the setbacks required along them and at the intersection, <br /> 9 Y � 9q 9 <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I ,�� o <br /> __ __ --------__ __-----_ -- i <br /> 5. Lot Size: Fig. A. 6. Location: Y' i <br /> ................ ft. x .............. ft. — ............................... sq.ft. ..................................................................... ......... <br /> in <br /> a <br /> N O <br /> O J <br /> J <br /> See Attached <br /> o vt <br /> 0 <br /> w <br /> T <br /> Nom" <br /> Z <br /> O <br /> A <br /> w <br /> b <br /> m <br /> lT <br /> J] N � rnr Dcgm 9 <br /> M c . W d ° c c <br /> ° N�p < J J n m <br /> m <br /> dCy > > 3 <br /> ow o m m <br /> Z.-.o ID <br /> ° NJ u n <br /> c a : <br /> � O OJ . <br /> c <br /> /C 1G fir' n : m <br /> ........................................................................... ...................................... p O <br /> Signature of Owner or Agent Date g <br /> N <br /> Remarksm a <br /> .................................................................................................................................................................. ...... m . <br /> u <br /> ................................................................................................................................................................................. ...... <br /> N N " n m <br /> Inscoon Date ....................................... .. .. 1.f/.!' ....I............... g....... ...... v-,cn . <br /> Pe Zoning Administrator 38 g g 59 fA <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has be n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans o specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />