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Burnett County Office of Zoning Administrator U 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. : :� <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '� 07 1 <br /> w <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the require is of the Burnett County Land Use m <br /> Ordinance, Sanitation Code and wi�'1all other applicable County Ordinances and the <br /> s an reg n, of the tate of Wisconsin. — a <br /> .L.(�4.� ... cy1.............................. «.... rr., 1.e 3 <br /> . ......... . _ <br /> OWNER (please <br /> It e 1� ) ACTORor VEYOR or AGENT ( o. <br /> ....... ... ...... . . . .......... . ....... .. <br /> aRESS N. AD RESS Y <br /> x ( p� t <br /> �� ... ..� . c.> ..../..!..�.i. .�1............... .�5.e......... ..4.1 .3.0................................................ <br /> ADDRESS ADDRESS :� �---•"' <br /> 5-Z;.-1A.'2........ - 3 s � 35=20s.s.:.................................................. <br /> PHONE PHONE .g1 <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRI LLER <br /> ........................................................................................... . .. .. ........... <br /> ................. <br /> ........ <br /> ........ <br /> .............. <br /> ........ <br /> ............... � J <br /> ADDRESS ADD....RESS <br /> 0 o <br /> ........................................................................................... . ....................................................................................... : p .A <br /> PHONE PH....ONE J <br /> Z (— <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° Ems• <br /> 1. Work: 2. New Building Details No. Bathrooms .......... rte: o <br /> New Building No. Bedrooms 'o <br /> „�, Tylatpf Construction: ......•••• <br /> Addition ......,,.. ... „ l'('� , „r Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ... .r� ft. x ...US,v z.. ft. •""'•"' : <br /> Filling/Grading .......... Height.).Z.....�Stories .....I......... 4a. Absorption Field Site: <br /> .......... Area .... � ...........................Moving Soil Type .................................... r i <br /> r o <br /> Mobile Home Slope .......................................... <br /> .......... <br /> Privy ........•. 3. Use (describe exactly, 1 -fa ily - Fare. Rate ................................... Z <br /> Well ....r...., h ,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... Seepage Trench .......... <br /> Camping Unit ,......... Privy .......... r <br /> .................................................... Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road t <br /> Q <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 27 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p <br /> _ _________________________________ _ ___ , J <br /> 5. 1�jSi y �/) 1 Fig. A. ocatio y <br /> .....D.. ... ft. x ..J�7.. .. ft. — .. ..�.�1.d.5.J........ sq.ft. ...1 .G ...UF,g��......�i..�!.l�'.r..... n i <br /> \^\ O <br /> V � P <br /> N <br /> Co <br /> � N O' <br /> J LQ <br /> O <br /> �lJ o <br /> J <br /> Cyt C ail 5 /4b mus/ <br /> J <br /> C m z <br /> F <br /> — = <br /> C <br /> U llat, z oo' m > � <br /> / bso <br /> wo M <br /> °V`. ...... . .. `5 ... .. .5.... . .................. - _ <br /> M <br /> �.� \ o C <br /> nature o ner-oF- \ Date <br /> t X 70 <br /> Remarks.....4��. ... . .. .n... '4...��.GS�..................................................................................................................... m p <br /> ........................................................................................................................................................................................ W II <br /> ................................................................................................................. .... ............... . .............................................. H <br /> mJ N J <br /> InspectionDate ....................................... ......... ....... .............. o u o u, o , m <br /> Z ning A inistrator $ $ $ $ to <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitles <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />