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Burnett County Office of Zoning Administra or �' 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 ind •Z <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he i LSA <br /> Burnett County Land Use Ordinanoe, n n Code, and with other � �able County Ordinances the laws nd » a - <br /> pt <br /> regulations oftheState ofWisc nsin <br /> .......... dVn ... � . �,. C j 9 <br /> OWNER��(pleaa/s�s print) CONTRACTOR or SURVEYOR or AGENT <br /> ........�;/.1G7`..�r......� Iflr. /✓1� K.......7/L.f.�L.................... <br /> ADDR SS ADDRESS <br /> AN sy/�! ssi3 - 2 <br /> .................................................................. 'A-6'DRES... -.S <br /> .. --...................................................................... ..... <br /> ADDRESS AD <br /> PHONE... ..............................�.:................................. .PHONE....................................................................... ... .1�0 <br /> D� .... !Q. t.f a 7.............................. GIQ '• <br /> ............... ........ . <br /> PLUMBER WELL DRILLER <br /> 6o2 <br /> ..................................................................................... . in o :o , <br /> ADDRESS / ADDRESS <br /> .............................................. ............................................................................................ 0 <. <br /> PHONE PHONE Z v, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o » <br /> 1. Work: 2. New Building Details No. Bathrooms .. ...... :0 'o �•�+ <br /> New BuildingNo. Bedrooms .... ' 'v <br /> ...x.. Type of Construction: •• <br /> Addition ........&f:E'.G.4 ......72.W. 7,47....... Septic Tank Size Gals. / .J..c�., <br /> . i0b Z <br /> Sanitary ,,,� Size .. Sf.... ft. x .....;R ft. $' v; <br /> Filling/Grading , ........ <br /> Height.....`U......, tories .....� 4a. Absorption Field Site: --cr: <br /> ........ <br /> Moving .......... Area .......2�. ................. ....... � <br /> Soil Type ..........49t-.O.... ...... a <br /> Mobile Home .......... Slope ..................�.�... .. -V 1'1\ » <br /> Privy 3. Use (describe exactly, -family Perc. Rate ....... T : <br /> Aft <br /> rj <br /> Well .......... � ome,garage, motel, etc.) Dry Well "' m <br /> """ <br /> Subdivision-- Seepage Trench ... ...... <br /> .......... .................................................... ���777 ppp <br /> Camping Unit Privy .... ...�.. <br /> Seepage Bed � . ...... /43 <br /> -- � <br /> --------------------------------------------------------- -- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. :y0 C rl <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locato d at9� gy�pp\ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. U\ <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------------------------------------------------------------- <br /> 5. Lot Sizrr: /r Fig. A. 6. Location: <br /> ..� •�a ft. x . T4 .. ft. — .... 1. �........ sq.ft. .P.r—'� z?.........�...ROA ......................... . :� �1i�1 i .. <br /> �.p :k <br /> 0 <br /> 3 <br /> T <br /> 2 O <br /> n <br /> A <br /> � Mdd > coco - <br /> n Hp < n > o - - m <br /> M N`a� � a 0 n a S <br /> a dcy > > � <br /> N : N p n b <br /> rn <br /> 0 <br /> {D.. . ...... .. ........ .7... ... x A <br /> A,gnatunler or gent 1'�/p//�/`/ Dat $ <br /> e�.`"'u_./�/i lir• T: _ w <br /> Remarks a <br /> n <br /> o : <br /> N m ru Nm <br /> Inspection Date ....................................... m.......... .. <br /> Zoning A nistrator <br /> $ $ $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl' ation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />