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Burnett'Cou hty - - Office of Zoning Administrator an a o 0 <br /> -`APPLI(CATION FOR SANITARY — LAND USE — BUILDING PERMIT - a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit far the work described and located as <br /> Shawn herein. Tneundersigned right that all work shall be done in accordance with the requirements of the Burnet[County Land Use v <br /> Ordinance. Sanitation Code,and with all other appl'e.od County Ordinances and the laws and In,ohlions of the Stale of Wisconsin. 3 <br /> ../�.�F..H ... ... ...... ........... CONTRACTOR or o. <br /> OWNER Ip�eese print) CONTRACTOR ar SURVEYOfl or AGENT <br /> A67AR.y.....ao.Vr�....,o,11<vim_..................... ..... . . - ............... <br /> . . . . . ............................................. ............... <br /> ADDRESS de <br /> ........................... ................._.....................................................I......-........... <br /> ADDRESS ADDRESS <br /> 6�2..-...9.35.-..2y.8 ................................... <br /> . ....................................................... .................................. <br /> PHOM1't. ............................................................................... PHONE :\ <br /> it <br /> PLUMBEfl WELL-0RILLER _ <br /> ............................:...................................................... <br /> ....... ........................................................ . ............. <br /> ADDRESS ADDRESS _ � .m ` <br /> ... .......... . . .................................................................... ............................................................................................ <br /> PHONE PHONE o <br /> Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... o ci <br /> New Building (... Type of Construction: No. Bedrooms ....... <br /> Septic Tank Size Gals.. <br /> Addition .....-...... ................ ............ .......... Y: <br /> Sanitary ......... . <br /> Size ... .2... f ft. x .....,?L.... ft. .......... <br /> Y.. <br /> Filling .......... Height...�f _.. Stories .....L........ 4a. Absorption Field Site: <br /> Moving .......... Area ........6.6.k..l�t........ ......... Soil.Type ................ ................... <br /> o <br /> Grading ...... Slope ..................... ................_.. ��.t� .. <br /> Mobile Home 3. Use (describe exactly, 1 � family Pere. Rate ................................... r: i <br /> .......... <br /> Privy ....... home,garage,motel, etc.) Dry Well .......... l?• d i <br /> Well �Tu Seepage Trench ....... �C <br /> .......... Q a..tr.fE.................... <br /> Subdivision Frilly Y ....._... <br /> .................................................... Seepage Bed <br /> to <br /> Location of Proposed <br /> bar svpndr res and existing structures. <br /> un well sewage systems,roads,etc.,should be,t, I loin Fig A.highway <br /> Include rad <br /> setback, side and back yard dimension and location and setback from all n,and of water. if prooerlC is locatd m e LEX Iy inter- I _d <br /> section, show the in[ersdoticg highways and the setbacks requlretl alon0 them end at the 'm[erswnon. CLEAR LV LABEL EXISTING 1' <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Vi o <br /> __________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft X . . . .. ft t. Atiovi. sq.ft. 1,AAja� - fc„c ....... <br /> — - --(k.A l <br /> TMItF-o/ rr`I_4ft4 /„AA - N - <br /> -l-h"E - o 0 1 <br /> Nom' <br /> o <br /> SEE 477A F <br /> ?o I <br /> z Z e <br /> P <br /> ` No„sE <br /> A I <br /> A <br /> p �o� e-lii1 <br /> N <br /> e a ond I .y <� z <br /> A ad Z <br /> . .0 <br /> da <br /> da <br /> _ . :. .' <br /> /��(//J <br /> Sig ...� ........... _._...�f( Date ........... 'moo i i C� <br /> ' Si azure of Owner m n[ Date — <br /> Remarks 1,91A ,44All!l._kvLo_._ .6..eF-a.aa -...Cf:.'e . rv.G .........._ o <br /> I i I <br /> o'e.....G.1 ..rf........ o�l . . . . . . <br /> fo....../�r.... /X7.rtrrc ,.pc..... <br /> JPew <br /> �s.../�vi..l�usa,�s NTt <br /> Ins dation Date .................... ............. ._.. ........... .. .......................... h <br /> M <br /> Zoning Administrator 00000 <br /> 00 o o o om <br /> NOTE: A preliminary situ inspealion must be made ind site approval granted on all s(,hctu,dS involving sanitary facilities <br /> before construction can begin. In the case of seweragd disposal systems, a copy of the percolation tell iitust be attached to <br /> this application before n permit will be issued- Do not purchase orinstall aseptic tank, do any Plornhin, or slap any build- <br /> ing until a permit has been issued. A hermit may be revoked if misrepresentation of any of the infOnnution conveyml here- <br /> with-ii round to exist. Changes in plans or specifications shall not I'd made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANO- APPROVED. <br />