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m 0 Z <br /> Burnett County Office of Zoning Administrator � 0 0 <br /> APPLICATION FOR SANITARY(— LAND USE — BUILDING PERMIT 3 0 <br /> I TO THE ZONING-ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described ant,Ince(M as ' in J <br /> I <br /> ,new, herein. The undersigned agrees that all work net be done in acco Nance with the repuiremen is of the Barnett County Land Use c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> De. 1,Al, DAAC M. D. <br /> OWNER)please print) CONTRACTOR or SURVEYOR or AGENT se <br /> M . .............I�r..STiu6S....n9Al................. .............................................._......_.............._....._....... <br /> ...._ <br /> nee.......Ess.....................................................SS o33 ADDRESS <br /> ADDRESS ADDRESS <br /> ................................................................................... i n <br /> PHONE PHONE t� 'rn <br /> N5....._.MEQr.ee._....................................... <br /> PLUMBER W .... <br /> WELL DRILLER <br /> .........'V ��S �.L....w.-? ............................................. ._................................. <br /> sq IS, <br /> ...._... <br /> ADDRESS ADDRESS <br /> m or <br /> . ......... o <br /> 7 <br /> PHONE PHONEZ <br /> DESCRIPTION 4. Sanitary Facilities: ° c ° oG <br /> vh <br /> Bathrooms ```` <br /> 1. Work: Z. New Building Details No. "7 'N o <br /> New Building .......... Type of Construction: No. Bedrooms .. .. <br /> Addition .......... Septic Tank Size Gals. 7.1M. <br /> Sanitary ... <br /> X Size .............. ft. x ...:.......... ft. - .......... '0 <br /> ....... <br /> Filling ......... Height............. Stories ............... 4a. Absorption Field Site: it <br /> ... ......._ <br /> Moving .......... Area ........_._.........._.................. Soil Type ..............I....... O..p <br /> Grading ... SIoPe .....�_ .................. <br /> .... ....... ' <br /> Mobile.Home .......... 3. Use (describe...etlyll-N-ily) Pere, Rate -"" -'L� N l Z <br /> Privy home,garage, motel,etc.) Dry Well .......... 1 <br /> WellSeepage Trench .......... <br /> . ........ _ <br /> ..................... ............ Privy <br /> Subdivision .......... ..�:.... :T [ <br /> ............ Seepage Bed <br /> Location of olposttt structures and existing structures well,sewage systems, roads,etc.,should be sketched in Fig A. Include brand A" : Tay .o <br /> IN be <br /> setback, side and tuck yard dimension antl Ipeetlon and setback from all bodies of wider_ It property Is located at a highway Inter- 0; <br /> -71section, show the intarssong highways and the setbacks repaired along them and at the interaction. CLEARLY LABEL EXISTING T < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �r .A o <br /> ----------------- --------------------------------------- ------------- <br /> 5. Lot Site Fig. A. <br /> ....�.Q...:.. ft. z x w!M_ ft. — ............................... s9. ft. <br /> � I <br /> p p <br /> - fl <br /> i <br /> �t�' Cts VII <br /> � I <br /> d <br /> n Nae< �IIn1 <br /> C: 'Illlne <br /> 0 3 : <br /> Na <br /> ( � �{ N <br /> YIL . . . ...! ..° �ti ................. . .. . . . .. L <br /> r�.. ..... <br /> � lG0 <br /> � I <br /> Signature of Owner or e 4genn1 f ` � <br /> / Data <br /> Remarks .c. .N.tt.�?.�L:'. '- �. <br /> . r.. e! C.c!i .... xv%`u7Ltta.cl.4.4T✓!'R+....y-...... . `_;d: ..........._.... <br /> .1.`�z.A.LC2:.°..._ ._._ —✓`+"'. ....G3.0 :..... ....... .............. .......... N — <br /> i <br /> .:.....................-............................... .......-................ ...................._........._........... <br /> ... N <br /> Inspection Date ....................................... ............_...._..._. 000�o <br /> Zoning Administrator <br /> NOTE: A Preliminary site inspection must be made and site approval granted on all structures Involving s gd H,,,lacihl,, <br /> before construction can begin. In the case of sewerage disposal systems, a copy of Inc Percolation lest most be attached to <br /> this application before a permit will he issued. Do not purchase or install a septic tank, do any plumbing or Salt any Budd <br /> ing until a permit has been issued. A permit may be revoked it misrepresentation of any of the information conveyed he, <br /> with is found to exist. Changes in plans or specifications shall not be merle without ajaproval of the Zoning Atlm in ivraml.I <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> 1 <br />