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Burnett County Office of Zoning Administrator vo 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 r0a <br /> �L' / l/I/ V C �i�' I4� i!�� s a <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT a <br /> a .../ Wca......J° .11/ ' ... .1�:T.......1....8�'X.�.9.. ........................................... <br /> A DRESS - ADDRESS m <br /> .,36Li�r�B�,o .. e s....................................................... <br /> ADDRESS ✓ <br /> ADDRESS <br /> 54 <br /> a. ............................... .... .. 9- 2si.......................................................... <br /> PHONE PHONE <br /> �v\ <br /> PLUMBER............................................................................ .WELL DRILLE..q............ <br /> ....... <br /> ........ <br /> ........ <br /> ...... <br /> .......... <br /> ................ ?G\ ^\ <br /> .......... <br /> ........................................................................................... .................................................................................. � <br /> ADDRESS ADDRESS m C, <br /> n o <br /> c <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 / T No. Bedrooms .......... <br /> ..fl...., ype of Construction: m <br /> Addition .....Cf.1i57.!72��.................. Septic Tank Size Gals. .......... E <br /> Sanitary ... ..... $lie .sZ.7' ft. x .oC ft. <br /> FillinglGrading .......... Height... Stories ..... 4a. Absorption Field Site z <br /> Moving .. ..... Area ... ....... Soil Type ........ .... .. ..... . .... .. <br /> Mobile Home 'f' �i By $/•vtT9tAEO F/sif/ Slope .......................................... z <br /> Privy ........ 3. Use (describe exactly,'1 -family Fare. Rate ................................... <br /> Well .......... home, garage, motel, etc.) Dry Well .......... <br /> Subdivision ��.`. GQ�i..� ........................... Seepage Trench .......... E '� <br /> Camping Unit Privy .......... <br /> .. Seepage Bed .......... <br /> -------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. 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 t a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection.LEAR Ly LABEL EXISTING r <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. -- i o, <br /> .------------------------ ------__----------_—__—_---_—___---____---_ \: <br /> 5. Lotize: pp / n Fig. A. <br /> � .�.Q. 6. Location: 1 <br /> ...... .C... ft. x 0.. ft. — .../L.7. Or O sq. ft. ............................................................................... <br /> 90 Cf <br /> h n <br /> N o <br /> \ T \N <br /> (� 6/ c <br /> H yv 75E kA <br /> W :V <br /> 39 7Nry y <br /> 0 on < 53- M N4 ,O —= <br /> �1 MuDNEzv l9CE" a m <br /> g� <br /> . .�av <br /> /9....................... ... A. /3. <br /> Signature of weer or Agenti,c[Ls.L../�1'� ,;..fin Ftp'Dafe p <br /> / X 9 <br /> A/ : <br /> Remarks d.0... ..1......4E..kw......e?✓. .. ....C,rF4rnH.cy... ?L?!.at/:..................................................................... <br /> as <br /> 0 e <br /> ........................................................................................................................................................................................ — <br /> �r II <br /> ........................................................................................................... .......................... ............................................. :t`t : . . . . . . <br /> T <br /> Inspection Date ....................................... /?Z. ./";,... .f.Q,f.G........................ u�r ren '0 8 o a m <br /> ZoningAdmihistrator <.1 8 8 8 8 8 8 (n <br /> NOTE: A preliminary site inspection must be made and site approval 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 Ite made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />