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Burnett County Office of Zoning Administrator C 0 0 <br /> 'APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 CL �\ <br /> fo... ..u.../11.....-... 'R......! G.......... .. .-,� - ¢-►-................. <br /> OWNER (please print) CONTRACTOR or SU VEYOR or AGENT a <br /> bL•wm... d....... !..!:�. �.R..!Re (sJ� ............................................................................................ <br /> ADDRESS ADDRESS <br /> B.¢.n. . ........ -. .K................................................. .......................................................................................... <br /> ADDRESS ADDRESS N <br /> .1..............I�.a...` ..3 j.. ................................. ......................................................................................... <br /> PHONE PHONE <br /> .W...ELL.... ...D..RILLER.. ...... ....................................................................... N :� <br /> PLUMBER <br /> .......... <br /> ........................................................................................... .A....... ..ESS.... v.................................................................. : o <br /> q�, <br /> ADDRESS DDR.. n <br /> U/ <br /> .............................................................................. . ...... .: <br /> ... <br /> PHONE PHONE. Z y <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••••�•••• <br /> No. Bedrooms <br /> o <br /> New Building „JC, Type of Construction: <br /> Addition1LRJ//.s'l�tg Septic Tank Size Gals. ...,.. ... <br /> Sanitary Size .. 4*0 ft. x ...A.. ..... ft. <br /> Filling .......... Height j I.S.... Sto les .. ............ 4a. Absorption Field Site: <br /> O Moving Area Soil Type .................................... c r <br /> o <br /> GradingSlope .......................................... <br /> Mobile Home .,,,,,,,,, 3. Use describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel,etc.) Dry Well .......... 'a <br /> Well c � Qy Seepage Trench x <br /> .......... ,,.!(„(lXY.�/)l1Lq,�...�-.�-... . 4Privy ....... .. <br /> Subdivision <br /> .......... ............................................. ...... <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 K , <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- rte.+ Q. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING -C 1N. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �p ° <br /> -------------------------------------------------------- <br /> 5. Lot Size: rr9zew Fig. A. 6. Lo ation: <br /> �..... ft. x .99.p.... ft. — .. ................ sq.ft. ...v. ................................................. e <br /> A <br /> c <br /> N o <br /> / O 7 <br /> 7 <br /> C7 'C <br /> N <br /> 'F <br /> 3C <br /> O ]7 <br /> t 7 <br /> �m <br /> r, V` <br /> M tnr -aNcoz <br /> C W ], M N <br /> 40 7 <br /> m NQ O. •<G ,r O.� <br /> R-o' m< <br /> I� Z oo° c i < <c <br /> o € <br /> b M <br /> oo '•'®� E E E m <br /> Of- <br /> ............ ....... . ........................................... 9... ... ...... <br /> E <br /> Signature nO nn_ or Agent �j •.J V Date r9 J o C <br /> Remarks .A\..4. X114e.(r....Ally.IL<n*!.....L�? `..... ...fi.t4&.4... GiN... .... ... . .....A x v <br /> .............. .... ........................... <br /> �Mr ......��L.:.�ZyiL't�1 .......... e U u <br /> Inspection Date i ..o ........................ 7 I o 0 0 o cn m <br /> .......... C <br /> At /a3 7 9 Zoning Admini rator ? ai o 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fact ities <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 /> e <br />