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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work. described and Ice ited as �T <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m c r— <br /> Ordinance, Sanitation Code,, and with with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin a <br /> �? �S I �rMill/119 lCGt4r� AFP ' � � o <br /> ..../(.��Cl....... . �..................... ............:.......................... u.st...................... ......... <br /> ........... <br /> OWNER (please prinU CONTRACTOR or SURVEYOR or AGENT <br /> �'.T...1........... o ......5 ............................................. :�F�...1.................................................................... ......... <br /> d <br /> ADDRESS ADDRESS = <br /> Si.r.P%t....r....l/tl.c..........5 '7. ................... �..itis :bv.r.p{� !.5......................... <br /> ADDRESS ADDRESS t/ - j <br /> A <br /> ................................. ................................................... .. .r..Y.77.................................... ......... <br /> PHONEPHONE jf A <br /> ...N..?6......,.1 vim.!e:PPI ..................................... :0Q : <br /> P MRER ........................................... ...................................... ......... <br /> • r WELL DRILLER <br /> Wr <br /> ADD ESS ADDRESS � � <br /> D6` OF ° <br /> .. ......... <br /> PHONE PHONEZ H r <br /> DESCRIPTION 4. Sanitary Facilities: 3 ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building +t ,,, Type of Construction: No. Bedrooms .�,?..... z a <br /> Addition .,,.,: ,ry/� �. ................... .. Septic Tank Size Gals. <br /> m i <br /> Sanitary .. ..... Size .. :M... ft. x ,5 ... ft. .......... <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: iJ r P <br /> Moving .......... Area ............... ........................... Soil Type , `r o <br /> / / T <br /> MODile Home 9��� � 7 X�T Slope .............�..�...-. ........... .. <br /> Privy ...,...,,. 3. describe exact) 1 famil Pere. Rate ...... .'. ...... ........... _ <br /> Dry Well <br /> Well .......... hom arage, motel, etc. .......... <br /> SubdivisionSeepage Trench .......... p <br /> . . ... ...... <br /> Camping Unit Priv.......... ................................................... y .. k <br /> ----- -------------- Seepage Bed y J F <br /> t.`.... <br /> -------- ---- -------------- — -- to <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc-, should be sketched in Fig- A Incl. e oad C <br /> CT <br /> setback, side and back Yard dimension and location and setback from a!I bodies of water- If property is located at a hlghwa -nter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersoction. CLEARLY LABEL EXI TING i <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. r o' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ._ <br /> f� :It <br /> N y O <br /> 0 3 0 <br /> See Se otwk <br /> V � V r in <br /> I m <br /> 61 z� <br /> 0 <br /> 7J (o r tJtn W Z \. <br /> n Q < c m <br /> ov; � � am <br /> 0 0 ? <br /> O <br /> O � <br /> p <br /> ig . .. .... .... . .................... <br /> ............. .............. ...................................... Oo C <br /> S -'nignature... . ... <br /> .of O..wner or Agent Date <br /> Remarks .................................................................................................................................................................. ...... „m m� <br /> ........................................................................................................ ...................... ... ...... ...................... ... . . . . <br /> ;(_�/��II . <br /> t '}•N <br /> Inspection Date ....................................... ... ...n.' g. ...... .....L.LLI'! .... ...... (LV�J N o o m <br /> Zoning Administr t r <br /> N <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures it volving sanitary fucilitu.. <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatim test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl robing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the in ormation conveyed here <br /> with Is found to exist. Changes In plans or specifications shall not be made without approval of t to Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />