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Burnett County Office of Zoning Administrator se 0 <br /> APPLICATION FOR SANITARY '— LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The um,,r red hereby makes apolication for o Permit for the work des.rmi add Incatul as _ 'C- <br /> Ordm heroin- The undersigned agrees al other <br /> work shall Redone In accordance with the repand data o1 the Burnell County Land Use 3 :.ns <br /> Ortlinanca, SanitationnCode,and 1viihall other aopliceble County Ortlinanca/e�d the laws and regulations of the State of Wlscorein. 3 a Ji'� <br /> L 1 f <br /> ..../ .... ':.:........................_... ... ................................ CONTRACTOR <br /> OWNER leas error CONTRACTOR SURVEYOR or AGENT - <br /> l) a. � 0 Ga rirc' � - <br /> ADDRESS �' ADDRESS <br /> ADDRESS '. ADDRESS <br /> �. <br /> PH PHONE _ <br /> r � <br /> PLUMBER � �.... � <br /> ......:........_.......:........_................................... ..................... .........:....._._.....................__................................:.. .....,..... <br /> J <br /> :4DDR ESS ADDRESS <br /> L . a <br /> is <br /> PHONE � PHONE � ° - <br /> o sa o <br /> '. DESCRIPTION - 4. Sanitary Facilities: I •• o <br /> 1. Work: 2 New Building Details No. Bathrooms ... jJ o <br /> New Building ' TY of Construction No. Bedrooms ... p m <br /> ppC <br /> Addition r "� ✓...... Septic Tank Size Gals ns. op <br /> .. fi�t++ .... ..... <br /> Sanitary tI Size aoVa ft x <br /> k... ft- <br /> Filling - ... Height Stories : 4a. Absarptian Field Site. <br /> / <br /> Moving Area ... Soil Type .....:.... "t o <br /> Grading' ...-..... Slope .............'............:._............ :cs <br /> .y Pers. Rate ............................ . iL <br /> Mobile Home ........_ 3. Use (describe exactly„ -family """' <br /> Privy ..... .... home,gauge, ii He,) Dry,Weli t "� <br /> Well _ ` Seepage Trench <br /> ..L_/ . ........... .......:..... ..........._............ <br /> Subdivision Privy <br /> _ ....... pp ..`.. <br /> _.. ............ ............:....... <br /> .....,.'"" .Seepage bed <br /> ------------------------------------------ <br /> )--------------- ads� \ 1 ,fir <br /> Location df proposed structures tl existing tornothes,well sewage Warren, to 1 tshould b. 6k t h tl a r, A Id,I1 ad :do t, 7-� <br /> setback s de and back yartl 4 ens on and location antl setback from all bodes of water. If property 's'located�et h 9hwav -titer Q d ' r <br /> section, show thea tersecting hlghwaYs and the setbacks tend red al ang there and at the in tersest l on. CLEARLY LABEL Ex ISTI NG � ^t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - o <br /> ------ ----- ------- --- ------- -- '.i <br /> S. Lot Size: - Y "` "'om `u /'00. Fig. A. <br /> / .... ft x .75D -I rt �:�, <br /> it„p N•yE- .8,,q. ft," ti <br /> is <br /> 9- <br /> xx0 <br /> J Li <br /> . re rnr gym- . <br /> re <br /> w�a v <br /> an °J1m <br /> ca 4 <br /> In <br /> /.... / T p be <br /> U'.tur weer or Agent Date - x b, fm <br /> Remarks//////.. Pasement must be .. walkout. if well is to be located 1RS.iCie dwell-in .� NO <br /> ............................ .. <br /> ........ cfG of / .... <br /> ii <br /> 8arr <br /> I nspection Data( ! - .. � � .(- fa/'sL� "" o 0 0 In <br /> Zoning AdmmistraYe <br /> NOTE: A prellm'maly site inspection t ust he made and site approval granted on allsvuctuies involving sulilary fact lltles ' <br /> before construction can begin. it the case.of sewerage disposal systems, a can, of the'mrcolatlon lost must le attached to <br /> this application before a permit will be Issued. Do not purchase or Install it septic think, (to any plunihing or Start any build <br /> Ing until a permit has been issued. A pcnmlt may be revoked if misrepresen ration of any of the information conveyed hire <br /> with is found to exist. Changes in Plans or specifications shall not be n ado without approval of the Zoning Adminlstrami. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> �`. Y <br />