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f0?7(&CVL/I <br /> Burnett County Office of Zoning Administrator fes' �� <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT m ;W <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� Oy' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance, Sotation Code and with all othr applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. 'j <br /> f1 ...cP (.R.�. �.. .............LD�?..!1 : . .............. <br /> tY............... <br /> NER (please print) NTRACTOR or SURVEOR or AGENT <br /> ADDRESS ADDRESS <br /> ..................................................... �. .?.......................... ............................................................................................ D <br /> ADDRESS ADDRESS .p <br /> -3��.. .....Z/.............. f a n <br /> PHONE PHONE :� <br /> t <br /> .. . ..................... .. k..s.............................. <br /> PLUMBER WELL DRILLER ~ <br /> ........................................................................... .A... ....RES-E-S-S.............................................................................. <br /> ADDRESS DDn O �- <br /> �. <br /> .. ........................................................................................ .f'PHOH"0".NE.................................................................................... N <br /> PHONE Z r 4 <br /> DESCRIPTION 4. Sanitary Facilities: P o <br /> 1. Work: 2. New Building Details No. Bathrooms ... .... ^ebt <br /> New Building rf Type of Construction: No. Bedrooms .......... <br /> Addition w.........rt E,,, .-5/.ytR Septic Tank Size Gals. <br /> Sanitary2 2$' 0 <br /> Size ....... .. ft"" <br /> x .............. ft. <br /> Filling/Grading Height............. Stories .. 4a. Absorption Field Site: <br /> Moving .......... Area ..... >sd .... l '~ <br /> Soil Type .................................... r T <br /> I� !� ... pi Slope .......................................... <br /> Mobile Home .......... CIS, 'tyy y <br /> v Parc. Rate ................................... i <br /> ww 3. Use (describe a mdy <br /> •,........ home garage, motel,etc.l Dry Well .......... z <br /> 102 <br /> Subdivision Seepage Trench .......... o <br /> .......... / .. ....... <br /> Camping Unit .......................... Privy <br /> .......... ..................................... <br /> Seepage Bed --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :9 C <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at ;� g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :� 0 <br /> ----------------------------------------------- ------- `• <br /> 5. Lot Size: Fig. A. 6. Location: J <br /> ................ ft. x .............. ft. . ............. .......... sq.ft. ............... . ............................................................ <br /> r l��/tly bLur,�e�; CQ3 •�o <br /> q$l i `J{ 'VEn t . L i R1rY1E'?T N � o <br /> /`a/ °+_ j hand L n lel, <br /> o t e maple, Cir-oye, 71��1 �S f o <br /> Sol <br /> 0 <br /> o <br /> ( 11 V <br /> tJ m <br /> 0 <br /> O <br /> iNL <br /> N <br /> 0 <br /> N <br /> f� <br /> 31 (n -oN r D W co -V <br /> MD. m ¢ ny <br /> 9 < C y p p 3 <br /> 8H : ; aim <br /> „o : .2a <br /> 0 En n : S <br /> K6 c o O <br /> 3S on <br /> '-ic�- 7 " G <br /> .............................. .............. ........................... ...................................... <br /> Signature of Cipher or Date <br /> Remarks . ...... T m <br /> rr...:..,�:.:................. ................................................................................................. ......... . ....... <br /> u <br /> ......................................................................................................?oval <br /> .............. . .. ................I......... .......... <br /> . e <br /> Inspection Date ...�?....1.:�......1..`........ •Tt1A.'� .....•.y.:C, � o <br /> y u <br /> Zoning Administrat r7 g <br /> NOTE: A preliminary site inspection must be made and site apranted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 been 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 APPROVED. <br />