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>7� L u» f <br /> Burnet Gounty Office of Zoning Administrator d 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 < — <br /> shown herein. The undersigned agrees that all work shall be,done in accordance with the requirements of the Burnett County Land Use m i <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 n <br /> .hn......A..:.....C�.k...e..�es.%.. oM se i N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> . . <br /> ; <br /> ....C...... <br /> ✓ � Ls. . : ...... .... ..................................................................................... <br /> ADDRESS Z _ M.evyS ADDRESS <br /> . . . ....O COMPUTER/SCANN <br /> � <br /> � <br /> ................... ........ .... . ..................... <br /> ADDRfsAooRess <br /> .�.. .. ss5.........`.f.s ...�.......................... _........................................................................................... <br /> PHONE PHONE <br /> . . .. ... ... .................. . .......... .............. ............. <br /> . 'L <br /> :C3 <br /> �j <br /> PLUMBER WELL.. . ....D.RI.LLER.... .... ..... . <br /> /� rmbQ f � <br /> ........................................................................................... ..................................................... .................. —. <br /> ADDRESS ADDRESS n o <br /> ... .............................................. ....................................... :� p �- <br /> ntki <br /> PHONE PH..ONE Z 0 <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° v ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .... i o <br /> New Building No. Bedrooms .. �; -a -G <br /> g .... Type of g�structlon: .. i f <br /> Addition ...,.,,,L(�llt... .,fi. Septic Tank Size Gals. .......... \� < ?af <br /> ......... � a.... �ao �i <br /> Sanitary ... . Size ...7..�. ft. x .... ..... .. .....""' <br /> Filling ........ Height ......... StoriesZ4a. Absorption Field Site:Moving .......... Area ....................... Soil Type ..........�..Q n V <br /> ................ .................. • :, i LU <br /> o <br /> Grading ......_.. Slope .................... <br /> Uhd .n � <br /> Mobile Home .......... 3. Use (describe exact<:l -family Fare. Rate ...................:t'............. .� <br /> Privy .,.,,...., home,garage, motel, etc. Dry Well .......... 7 <br /> Well ....... � <br /> ........�/ .. <br /> Seepage Trench r <br /> .. . <br /> Subdivision .................................................... Privy <br /> .......... .................................................. 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 <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway inter <br /> section, show the Intersocting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: IkQ Fig. A. 6. Lo ati n: : U - <br /> e.� 9 1, <br /> ff — .....'\0. \.rl S.a.N. p }� <br /> ................ ft. x .............. ............................... sq. ft. ...................�...................... . <br /> i o <br /> e2 y <br /> 3I <br /> N ^ .� O <br /> o � '3 <br /> ea <br /> 0 C <br /> V: 0 <br /> Z 171 <br /> O <br /> r- JJ <br /> TSS ea <br /> it <br /> Q �Sn m iv �� d <br /> 3 '11 <br /> d <br /> Zo o <br /> Ell <br /> )g"K"' f Owner or Agent Da — <br /> 7 <br /> �CZ � .... ` <br /> xrin <br /> RemarksZ. ... ......................................................... ... ........................ ............. <br /> �j` � '.. .............. Le <br /> .................... ..... 1p <br /> fl r' <br /> .................../..........,../..................................................................... . .............. <br /> Cl M <br /> Inspection Date .W......... ... ..'�.... ......... .... ............ . ...... ........... . o m <br /> Zoning ministrator 0 0 0 o o fn <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, n 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 staff any build- <br /> ' until a permit has been ISSued. A permit may be revoked If mi srepi esen tat loll of any of the information conveyed here <br /> found to exist. Changes In plans or specifications shall not ba made Without approval of the Zoning Administi,itof . <br /> -R SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />