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CEJ C`c�17 <br /> Burnett County Office of Zoning AdministratorO o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < — •:� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c r <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances d the nd reg lat'nnc Wis;grnsrn..__ 3 a O <br /> MARVEL MC /L2i{1 C t rr f- i4 - 0 <br /> ...1.... n.. N <br /> ...............leas...................................................................... .. ...........................J'RV. ...... -o'r' ........ T—...... .... ) <br /> OWNER ( lease print) NTRACTOR or SURV OR or AGENT <br /> Rei ao z�� S- ALv,�iiL 02f�� we __'rs_T ... ///E <br /> a C pie �� a <br /> .......................�...................... . ... ... .................. ........................ d <br /> ADDRESS AQRESS---------.-- <br /> �! E/jSYR........................................................ <br /> sY 89 3 <br /> t <br /> ADDRESS f ADDRESS Yli <br /> ..-...>3.�.3.............................................. ....... ................................................... ............... ............ . <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS <br /> o i , <br /> PHONE PHONE Z — <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building „h,,, Type of Construction: C✓t a4 44-- No. Bedrooms .......... <br /> Addition (a'/zit o...... a.��r(i1.9i•� eau.�� Septic Tank Size Gals. .....,.... v P�' <br /> ......I... .0 <br /> Sanitaryc� ft. •"••••••• •� i <br /> ........ Size ...� ..�ft. x .... ....... <br /> Filling/Grading •..... Height..1-3...... Stories ....... .. <br /> 4a. Absorption Field Site: <br /> Soil Type .................................... �1 <br /> Moving .......... Area ..... ... . .'I yp yo, <br /> Mobile Home u�q,�?3 �r ..... Slope .......................................... <br /> Pere. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family �- <br /> Well home,garage, motel, etc.) Dry Well ......... <br /> .......... . <br /> Subdivision <br /> e- <br /> Subdivision .... . . . . ... .... I Seepage Trench .......... <br /> .....,.... <br /> N ia� <br /> Camping Unit ,,,,,,,,,. Privy .......... <br /> .................................................... <br /> Seepage Bed .......... T <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in PIg. A_ Include road <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> —_.-------------------------------------------------------------------- <br /> 5. Lot/ Size: Fig. A. 6. Location: <br /> ....(..V....... ft. x .............. ft. — ............................... sq.ft. ............................................................................., :? <br /> b <br /> Z CS <br /> N o <br /> _� � � N <br /> 0 <br /> `yp a( � jp T O <br /> Z <br /> y l.. - � . � r�vgdmz <br /> m <br /> O (J1 G <br /> yam\11 o of n� 3 <br /> Cb <br /> Sign e of Owner or Agent Date <br /> X DO <br /> Remarks ......................................................................................................................................................................... m m <br /> ........................................................................................................................................................................................ <br /> <s ' <br /> ................................................................................................................................ .. ...c. . ............................................ . . . . . . <br /> tra�u�.. fl1 <br /> Inspection Date � m � "' m <br /> N <br /> ZoningAdmi i trato 0 0 0 0 0 <br /> . ... <br /> NOTE: A preliminary site inspection must be made an tSit':11'-11)"10-v-a- I 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 not 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 if 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 Aclministratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />