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6��. <br /> Burril County Office of Zoning Administrator Ln 0 0 <br /> APPLICATION FOR SANITARY LAND USE — BUILDING PERMIT d 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable Coun y Ordinances and the laws and regulations of the State of Wisconsin. <br /> G/Pn�.../1'lR. .....-¢......��i..Lrr ¢dl soh N <br /> ... . .......... . . <br /> OW (please print) ," CONTRACTOR or SU RV–'E' or, AGENT a <br /> .ew.�fP.C.r.......' 'is... a ti <br /> .....-.. i ... . .. . <br /> A D ESS ADDRESS <br /> ......................................................................................... . ............................................................................................ <br /> r� Z <br /> ADDRESS ADDRESS <br /> PPHO��- PHONE <br /> Pi. r.c....... /Ps.a.h................................... . ..................................................:......................................... <br /> PLUMB R WELL DRILLER <br /> /� .../..... lr�.6r!. ....... Ntl <br /> s .r ..3.... . 1 <br /> ............................................................................................ <br /> 4,31DIRESS ADDRESS <br /> M o <br /> ........... �.......... .�f.f .......✓VS s?................ . ............................................................................................ <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: / ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Bulldi Details <br /> New Building Type of Co struction: No. Bedrooms ..-7 <br /> .......... m ' <br /> Addition _ Septic Tank Size Gals. `J..a)-V 3 � <br /> ............ . . ..... ......... rr <br /> Sanitary ...� Size ..�Y.. .. ft. x .aC...D.. . ft. f ' <br /> Filling/Grading „ ,,,,,,,, Height...(y. Stores ... ....... 4a. Absorption Fi d Site:/ m <br /> Moving .......... Area /... . Soil Type ... lt/g...C” ... �: '.V r- <br /> .. <br /> i <br /> ........I.... .. 1 <br /> Mobile Home ... .... . ... Slope ...................P..... ............. .. <br /> Privy .......... 3. Use (describe exactl 1 -famil Pere. Rate ....... ..................... .q <br /> Well ,,,l, � home,garage, motel, etc. Dry Well .......... <br /> Subdivision Seepage Trench .......... i " i <br /> ................... ..............................�.. <br /> Camping Unit ,,,,,,,,,, Privy .......... h <br /> ' <br /> ................... ................................ U ; <br /> Seepage Bed ` <br /> Location of proposed structures and existing structures well, s wage systems, roads etc., should be sketched in Fig A. Include road :� [ <br /> setback, side and back yard dimension and location and setba k from all bodies of water. If property is located at a highway Intervl <br /> - 9� o- <br /> section, show the intersecting highways and the setbacks requlr id along them and at the intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDIT ONS. <br /> o' <br /> 5. Lot Size: fig. A. 6. Location: firi . <br /> ................ ft. x .............. ft. — ............................... q. ft. ............................................................................... <br /> A <br /> m <br /> N O <br /> O <br /> 3 <br /> O � ; <br /> o ]a €v <br /> ° <br /> 'ItS 21 w <br /> Z <br /> 0 <br /> na <br /> T v m <br /> na- <br /> cr <br /> N _ m m <br /> O n < w c <br /> y a <br /> m <br /> o 0 0 n <br /> as l 0 <br /> G W_ <br /> : . ..r .. m <br /> e <br /> p <br /> Signature of Owner Agent Date iV° . C <br /> /D yd'D <br /> Remarks :�.4,J ?!? !.;#... ............................. .............................................................................................. x C <br /> JJS�P�� m <br /> �L tLLLtV ntze[o ,aor>w Cu.ts7r. 4�r� L - !h....................................................... e, <br /> ' � u <br /> ......................................................................................... ................ : : : : : : <br /> ^7 �/ r� iC n <br /> Inspection Date .../..-d.......P.. .......... .... ..!"J ....�.............. ........................... u 8 o e' 0e' m <br /> ....... ........... ... : c. . . . . m <br /> Zoning Adminis ator : I . 8 8 8 8 8 8 VN <br /> NOTE: A preliminary site inspection must hem <br /> de and site approval granted on all Structures involving sanitary facilities <br /> before construction can begin. In the case of sew rage 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 e revoked If misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specif cations shall not to made without approval of the Zoning Adm in istrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />