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Burnett County Office of Zoning Administrator L' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;W 3 <br /> TO THE ZONINe j ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown 'renin. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> 91Yl <br /> O <br /> ...)........... .... ........................................... v. ............................I......... <br /> OW .E.RYease print) <br /> CONTRACTOR or SURVEYOR or AGENT w <br /> SPA <br /> Lu <br /> ..!�.A....a.`f�.... I7 � 70 a <br /> ADDRESS' �... . ................................................... ADDER/ESS ,C. SII <br /> a oR.L nr�...wr......... 8.13......................... ....V.Y...e.6S.f.e.✓....1.....W1............................................... <br /> ADDRESS <br /> PHONE <br /> .. .................................................... .P.'.66....".. ...36........................................................ <br /> HONE <br /> s <br /> .............—...................................................... L...D..RILLER... ,L'E'...................................................................... � <br /> PLUMBER WEL <br /> ........................................................................................... .ADDESS. . .R. ................................................................................. .o <br /> ADDRESS <br /> ........................................................................................... . . . . ................................................................................... <br /> PHONE PHONE Z o r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms .. <br /> 2. New Building Details ����� �� <br /> New Building ,,.,,,.,., Typg of Ct7^�onsZ[uction: No. Bedrooms .......... <br /> Addition ..X, „ ..,.,.,°.q,�( ra,rif................ „ Septic Tank Size Gals. <br /> Sanitary .......... Size ....+3..a.... ft. x � ft. Dry w`ti <br /> PillingiGrading ,,........ Height.......;....... Stories ...1.......... 4a. Absorption Field Site: <br /> Moving ....4..... Area ....ra.�.Q.......( .f Soil Type .......4............................ r- <br /> Mobile Home Slope .......................................... o.+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well h4 me,garage, motel, etc.) Dry Well .......... <br /> r [��//^^ Seepage Trench <br /> Subdivision .......... .L:u!Af,� I'e a,M f 2fJ„/;,ipe <br /> rL .j/y1 .. Priv ' <br /> Camping Unit .......... ..&.....JAL!.✓.'..776. ..agtbrr7 it!n... y .......... <br /> _____--___________________________✓ _l�— _____ Seepage Bed_ ivl <br /> N <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc-, should 6e sketched In Fig. A. Include road �j Q <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. <br /> o' <br /> ------------------------ . --------------------7�---- <br /> 5. Lot Size: FigA. 6. Location <br /> P <br /> Lo.a.... ft. x ...Y.O.O. ft. — ..`..... �.° '......... sq. ft. fla.:ya...l f!�.S< t.' ..4 y.�..le-.H..1.�. <br /> kit,1.54,rom 2d, ✓ <br /> n <br /> I� o 0 <br /> 0 _ <br /> loo <br /> 0 <br /> I � <br /> 5{ed k io�t Y31 <br /> 5� 1 <br /> (� c o <br /> Weil <br /> c m - Y a <br /> ®ry t q0 <br /> 22' <br /> _ n <br /> O °�- �X[sfr.� t�- N 01 c m 9 v cLO m <br /> NO- C 'G dpi <br /> i 5C6 In 5 : ,� m c D <br /> 0 in <br /> / C oan <br /> V L <br /> 0 <br /> VOL e 87 �� m <br /> .. ..... ................................... ..... .........�.......... o p <br /> Signature wner or Agent Date <br /> X �1 <br /> T <br /> Remarks ......................................................................................................................................................................... mm � <br /> m <br /> :�II <br /> ....................................................................................................................................... <br /> w T <br /> .....�..Q........... ..... .................. <br /> Inspection Date ....................................... .... . . . "li ���� N U 'o o m <br /> 1 , '!. �^�' � «GYRI`^ !..✓ill......... ggg8 ' NW <br /> C�9 Zoning Administraf�r <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 /> - <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />