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✓79 CL`PT 17 . <br /> Burnett County Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. <br /> OWNER (pl se . . ....................... <br /> N O <br /> ......... <br /> poo.r. AG. N ... <br /> ............... <br /> a <br /> r .... j .R ....,�............................... ............................................................................................ a �2 <br /> ADDRESS <br /> ��y K.i2 f3., / ......l��i SG.....✓`�� ............... _ <br /> ADDRESS <br /> ADDRESS <br /> '�: <br /> .................... .. . .... ................................. . .......................................................................................... I � V <br /> PHONE t PHONE <br /> . ........... . .. . ....................................................................... ` C <br /> PLUMBER - WELL DRILLER O\ <br /> L . . ........ . ......................................................................... <br /> ADDRESS ADDRESS ^P m o A <br /> 'AI✓..a/. ...........r./....4�. ................. ....................................... <br /> o <br /> PHONE PHONE <br /> DESCRIPTION 4. SanitaryFacilities: �° o -� <br /> No. Bathrooms 3�' -10 ` Q <br /> 1. Work: 2. New Building Details "' "' hep i <br /> New Building ,....,,,,, Type of Construction: No. Bedrooms ..�.... F\ <br /> Addition .................................................... ank Size Gals. <br /> Sanitary ...,1.�. Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorptic{f/Field Site: 'lit 4 '• <br /> SoilType ......................... .......... <br /> Moving .......... Area ........................... ............... � 0 <br /> Mobile Home . ........ Slope ............................... .......... U .+ <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... <br /> Well ..,? ... home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench .......... <br /> Subdivision ...,,..,.. <br /> ...................................... <br /> Camping Unit Privy .......... t <br /> Seepage Bed .......... <br /> o <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig. A. Include road p <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- O a <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................. sq.ft. ............................................................................... <br /> n <br /> .O. <br /> N ' <br /> 0 <br /> S <br /> O <br /> M <br /> d <br /> n;)�j O <br /> ev <br /> 9 N r m W Z <br /> o' vNi �. C . m <br /> m O m m <br /> � _ <br /> z oo oD. n70 <br /> o <br /> on <br /> _ m <br /> m <br /> Sign of Owner or Agent Date o . . . <br /> Remarks .C:�/.. �,Z.ccO� GG Jabs /, ..�PntG......................................................................... 0 <br /> . ....................... m <br /> ........................................................................................................................................................................................ <br /> of <br /> ........................................................................................................ ............................ .. T <br /> ZoningAdminiZ�✓ �h f i ao g 'k g m <br /> mInspection Date ....................................... � ... � ......, rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 />