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C 'l ClitCCn-( , <br /> Burnett County Office of Zoning Administrator Cl)cum 1 H z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a <br /> B <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< v, �1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ca c V <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances <br /> and the laws and regulations of the State of Wisconsin. 3 a <br /> 6cQc e- e..h/9 f elf ° <br /> OWNER (please prin y <br /> CONTRACTOR or SURVEYOR or AGENT o <br /> I . <br /> _, <br /> ,3cE. <br /> ADDRESS ADDRESS ,-i• <br /> 'SC. 5'/ = . <br /> ADDRESSADDRESS <br /> 656 ^ 7$0 2., <br /> PHONE PHONE 't <br /> PLUMBER WELL DRILLER <br /> 0 <br /> ADDRESS ADDRESS �' <br /> 0 <br /> o' '+ <br /> PHONE PHONE N • <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Construction: No. Bedrooms z <br /> CD <br /> Addition ✓ FP')Iti Septic Tank Size Gals. <br /> Sanitary Size / (4r. ft. x <br /> <P ft. <br /> Filling/Grading Height. Stories ....0.1.4, 4a. Absorption Field Site: <br /> Moving Area .....2-5- y Soil Type r— <br /> Mobile HomeP U Slope W ° <br /> Privy 3. Use (describe exactly, 1 .family Perc. Rate 9) <br /> Well home,garage, motel, etc.) Dry Well <br /> Subdivision -51,.-4.. 6,4 Seepage Trench tP+ <br /> Camping Unit Privy QJ <br /> Seepage Bed p <br /> cn vM <br /> cLocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road 1 l <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 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. H <br /> •-•-1 = v ' <br /> 5. Lot Size: Fig. A. 6. Location: Ci <br /> ft. x ft. — /50. C44-5..S sq.ft. <br /> 4 . <br /> Cf) <br /> CDh <br /> 3€_..A---' alti—eN o <br /> o m <br /> 7 <br /> 90 <br /> co <br /> N <br /> ,- <br /> H <br /> O <br /> 0 <br /> `1 S <br /> T <br /> o <br /> O <br /> Do <br /> sun <br /> in <br /> CD <br /> U <br /> 1 <br /> Do (n r- v 5 to.CD Z <br /> o �3 a a� m E. a E <br /> • tv . c w rA <br /> �' cTl < w c 'O <br /> h• �n rn <br /> . Z O o' D a <br /> 70 <br /> o _z a C <br /> • <br /> WPP m • —I <br /> etliz_____ ,4 .(1).- ao-cEci L.,-, <br /> Signature of Owner or Agent Date ° C <br /> X 70 <br /> Remarks m m <br /> 0 0 <br /> fa <br /> dn <br /> 49 m <br /> Inspection Date 94,7ilra., 1g o c~'i, o c�i, o N m <br /> c�'i, <br /> Zoning Admini rator tc i 0 0 0 0 0 0 N <br /> IOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> iith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />