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/f7C� �?" <br /> Bur ett County Office of Zoning Administrator 19 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> r� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and q d� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of W' onsin. _ p <br /> ��^" R • ....�An........................... <br /> ........................ :.t°..1.r................................................. . <br /> :....w���Je!1........ .... . � r <br /> OWNER Iplame prim{ CONTRACTOR or SURVEYOR or AGENT i <br /> �R I .o.` ...... <br /> a�c...7 ......................... ............ ..................................................... a <br /> Aoo��RESS ? ADDRESS : l2 <br /> 5 .g:3o................... ............................................................................................ <br /> ADDRESS .. . .. ..................... . ADDRESS <br /> .rr6..-..8.4..6. ...............I........................... <br /> PHONE PONE rt <br /> �.. a.n.firti s.................................................... .. n... G ............................................. <br /> PLUMBER WEL RILL R _ <br /> ......... ................................................................................. A. . ............................................... <br /> ADDRESS DDRESS m 0 :A <br /> fh <br /> PHONE PHONE Z 0 � :a <br /> DESCRIPTION 4. Sanitary Facilities: I B <br /> t. Work: 2. New BuildingNo. Bathrooms ...... ... C? c <br /> X Details No. Bedrooms 1 . <br /> New BUIIEInp „(..,,,, Type Of nstruction: D . <br /> Addition .......... .4 CCwv - ` Septic Tank Size Gals. <br /> Sanitary Size .:�.�.... ft. x .3 ... ft. <br /> 'X.... 4a. Absorption Field Site: <br /> Flllinpr Grading Height............. Stories .....2,....... i `• <br /> Moving .......... Area Soil Type .................................... a i <br /> Mobile Home Slope :f} » <br /> .......... <br /> . <br /> Privy ,,,,,,,,,, 3. Use (describe exactlyPerc. Rate ............. ..................... w <br /> ,'1 family o <br /> wait-- �!�![� home, rages motel etc.) Dry Well :5 <br /> Subdivision Seepage Trench .......... o 'H <br /> .......... . �" AM.t.... ....�A.M.Pr...0... Z <br /> Camping Unit Privy .......... ,O \ <br /> .......... ......................I................. ....... Seepage Bed <br /> ---------------------------------------------------------------------- <br /> :� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched ijn Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at - <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. :(N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : T o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Q� Fi A. 6. Loc tion: L <br /> ................ ft. x .............. ft. - $'U..ac.re5... sq.ft. - N.Pp-.�. ..: .E./'{....d� .S2a....S!..�.Qk... <br /> �and <br /> _ c <br /> f f <br /> 2 <br /> 0 <br /> %' m <br /> i <br /> k <br /> / (nv U) 1- D mmy <br /> � HC < om "O 00 E. E. m <br /> o NZ' 0 c y 0 m EL a 3 <br /> 8 N : Q N O m m <br /> O <br /> MO . •Z D - <br /> RS00 m <br /> Signatur of Owner WAgent Date 8 <br /> Remarks ......................................................................................................................................................................... m <br /> m .. <br /> �. <br /> ..............................................................................0................................... ................. tl�l 8 : g <br /> Inspection Date ....................................... ..... . ' ............. ......................... . : cT fn v, o o en m <br /> Zonin9Administrator 8 8 8 8 8 8 m <br /> NOTE: A preliminary site inspection must be made and site proval granted 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 />