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r— <br /> (Burnett County Office of Zoning Administrator <br /> APPLICATION FOR. SANITARY — LAND USE'— BUILDING PERMIT a 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes applica[lon far a Permit for the work described and located as <br /> r shown Herein. The uMersigned agrees that all wore shall be done in accordance with th,requirements of the Burnett County Land Use ry . . °W <br /> Ordinance, Sanitation Coca,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n �--' !'Ai <br /> '�.., v L d <br /> { .acct �........... ...y_Pi ............. N1B% T-_:.. r§UR EYORo........................._..........._.._ � <br /> j0 ER (Pleasep�rind CONTRACTQR or URVEVOR or AGENT <br /> 3.(?a......ktc.Luba.r..4.....AUz..._5�. .................. ..................._.............................. 3 <br /> .ADDRESS A�RESS » VC <br /> ..... . ................................... ...................................................... <br /> ADDRESS ADDRE s :RS <br /> �' — ga.Pa....._................................_...... <br /> PHON P(J .... .......... <br /> ../..../...... .... eY eeY................._........... ...H..buE....................................................I.......... <br /> ................_ <br /> PLUMBER _ WELL GRILLER <br /> ..DD ... ....................................................... . .................................................................................... <br /> A ...... o_ <br /> 00 ADDRESS <br /> o p !_ <br /> PHONE PHONE Z � <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building X Type of Construction: No.Bedrooms ..�.]/..�... <br /> ... Septic Tank "zr� tis. ll1LN A, <br /> Addition .... Size .{"Q.iM..t..................... .. <br /> Sanitaryr <br /> .1...... Size ....Y......... ft. x Stories <br /> .�..... f.. 4a. Absorption O Sit <br /> Filling ....... Height............. Stories ............... 4 \ <br /> g ............. . . ... Soil <br /> Motrin .......... Area . . .................... .. )) �✓j�� <br /> Grading ....._... Slope .........../. . Q.^,�..... <br /> Mobile Home .._...... 3. Use We..act[ toned ere. Rate ...... <br /> Privy .... ..... home gang motel, etc. Dry Well .......... I !n I <br /> Well ...�.Y.X..a.t......9........ Seepage Trench ..._._.. .` 1 d <br /> Subdivision ........... PrlvY .......... <br /> Seepage Bed .... R�1 QJ <br /> Loc auto p1 prapOSed structures and existing structures,well,sewage systems,roads,e10..Should be skel<hN In Fig.A. Include rpntl <br /> setback, side and hack yard dimension and location and setback from all bodies of water. if property Is located at a highway Inter 1 ' <br /> section, show the intersectieg highways and the setbacks reguired along them Intl at the in[ersectipn. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p <br /> __________________________________________________________________ SI I <br /> 5. Lo/i SiIze) O Fig. A. 6. Location: <br /> a� ` to 1 <br /> 5 4 <br /> C, V <br /> 0 <br /> 71 a � <br /> `D <br /> A <br /> UV <br /> E en <br /> n, vn <br /> EL< f <br /> 2 00 <br /> a3- y <br /> /J�/ ... ............................. ..... .... .................. ...... v o <br /> Si)��,Aw eh r r ge Date i ! <br /> t <br /> i <br /> Remarks <br /> .................................................................................................................................................. <br /> .................................................................................................................................................................................. <br /> ...... <br /> ......_.._..............._............... ._............................................................ ;. , [: : <br /> Inspection Date ...................... ................ l Q'1'tGC7.Clv....... n o cccc0 0' <br /> Zoning Adou r T' 0000060 <br /> a <br /> NOTE: A Preliminary ,to Inspeetlnn mubd <br /> must try mail, nd site apted proc.il granon ;III structures Involving sanitary fecilitii <br /> before construction can begin. In the case of sewerugn disposal systems, a cop, of the percolation fesf.m est be etlachled I <br /> this application before a pencit will be issued. Do not lurches, or install e septic Ionk, do any plrmbi ng or star ttroy builli <br /> fog gold a permit bas been issued. A p,rnti[ entry be r euked If re1111111"ensu lion of any of the IIItion convr.yed her! <br /> with '($ found to exist. Changes in plans or specdicafions shall 1101 be made without approval of the Zoning Administlatu <br /> SEWER SYSTEM, SHA LL NOT BE COVERED UNTIL INSPECTED BY III IS 0FFICE AND APPROVED, <br />