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t f :I <br /> / r <br /> Arnett County Office of Zoning Administrator Cl) l 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. -. <br /> O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < o Z. <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c-oo C 1b� <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. -j. a 0` <br /> ' o O <br /> )WNE (please print) CONTRACTOR or SURVEYOR(1 <br /> ,co „ co <br /> e&)iI 7 Gt1 i e /, 42/ Q <br /> \DDRESS ADDRESS ,- <br /> co <br /> \DDRESS ADDRESS � ea <br /> 'HONE PHONE pc) <br /> I <br /> 'LUMBER WELL DRILLER <br /> 0 <br /> \DDRESS ADDRESS coG) <br /> 0 0 <br /> o r+ <br /> 'HONE PHONEz H r <br /> DESCRIPTION 4. Sanitary Facilities: . o o <br /> I. Work: 2. New Building Details No. Bathrooms o alt <br /> New Building Type of Construction: No. Bedrooms c <br /> Addition Septic Tank Size Gals. 4 E\ <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope h <br /> Mobile Home 3. Use (describe exactly, 1 -family <br /> Perc. Rate .b <br /> Privy home,garage, motel, etc.) Dry Well 4:. <br /> Well Seepage Trench 1.03 <br /> Subdivision .,K' <br /> Privy <br /> Seepage Bed _> <br /> Cr) <br /> _ocation of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road 0-. m <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 /> ;action, show the intersectinghighways and the setbacks required alongthem and at the intersection. CLEARLY LABEL EXISTING < <br /> q 7-,:'';.'...:4 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O -•- <br /> c - <br /> 5. Lot Size: Fig. A. 6. Location: __ <br /> ft. x ft. — sq.ft. r <br /> s, -da-4.64, e ./i-, c.„ <br /> ....__. ,.Do <br /> -7 N , O <br /> / ,/� O �-I 7 <br /> yI9 (( a O <br /> _. _ \ <br /> CO <br /> N <br /> ,-s <br /> Eo <br /> C <br /> 'Jf) 0 <br /> o. <br /> z <br /> mil <br /> a) <br /> C <br /> r` <br /> 6 <br /> -1 <br /> x, cnr7 * Ncoz <br /> m c -t. c W c co <br /> -o: cn <' m 5' O <br /> — o H. < ca `e m <br /> z o : : m 70 <br /> oz z <br /> cnca - <br /> J10 <br /> o <br /> 73 <br /> -�3 �y 1)o p <br /> Signature of Owner or Agent Date .t.X C <br /> Remarks Z` ` .:-.7175/ . js m <br /> u <br /> \'' <br /> W � <br /> �� s.3 11 <br /> �. 00001 m <br /> Inspection Date ,,,,.9e"71# 7&".. <br /> 60c0o6m <br /> Zoning Ad mist <br /> 000Coo fA <br /> JOTE: 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 /> /ith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />