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L, <br /> Burnett County Office of Zoning Administrator ivo Oz <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 'CD 3. g *� <br /> ° h <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H \ <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 a <br /> r+ ° O <br /> 7,, <br /> 0N,' A, /? y/42.4 y <br /> mv <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a eco <br /> le D U TE Al/- !.(,E"/ , .7 AZ 7., /f ..N.f:4 L- Q <br /> ADDRESS ADDRESS <br /> X'9CP7�" 7- /ii-^/35Te/2 <br /> ADDRESS ADDRESS A�.l <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> C). <br /> ADDRESS ADDRESS 0 o <br /> r+ <br /> PHONE PHONE <br /> 1. ° <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms n <br /> 2. New Building Details o : t <br /> New Building Type of Construction: No. Bedrooms CD <br /> Addition .AF..�r.. n'/G' c'4/z.44t Septic Tank Size Gals. <br /> Sanitary Size J . ft. x 21/ ft. <br /> Sks <br /> Filling Height.....�� Stories / 4a. Absorption Field Site: , <br /> Moving Area .3.e1/..., F1 Soil Type r- <br /> Slope 4 ° <br /> Grading 2. <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate p <br /> Privy home,garage,motel,etc.) Dry Well I <br /> Well 4/eA 4 4 Seepage Trench d <br /> Subdivision Privy ga <br /> Seepage Bed <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road c <br /> a' <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 intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING N• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 5' <br /> z <br /> 5. Lot Size: /e),/ 'r4/4/!4 5 Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. ./' " ' T /- A92-75 5-7- /cgE 1,¢.vz/ <br /> c^ 72 c <br /> cn <br /> CD <br /> n <br /> N o <br /> o m <br /> um <br /> \ 1 nV o c <br /> Co <br /> G <br /> j Gv -no <br /> 0 a o <br /> o� cocp <br /> � A/1 4 <br /> o <br /> N ) Q.L1 ---- ff45 — 41,j VI <br /> ,J a,ti•G 22-8 E. <br /> UC r -o* cncoz <br /> -a 0-1Z N 5' <br /> r* oy.y < u m <br /> Z oo fD • a23 <br /> �_`_ _ — ------_ --- o 3 o 3 <br /> 0# a / „ / <br /> u.10 MI <br /> 0 <br /> m <br /> , oyo <br /> Signature of 0# Agent i <br /> Date tN9X 53 <br /> Remarks 7--./.0'A' #� m k. m <br /> m <br /> to 1I <br /> n <br /> to <br /> m <br /> Inspection Date 7.-A-iff-e--41-20-fre..) 0000 cNr, m <br /> p GCmliZoningAdministr 'obbbAoy <br /> VOTE: 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 /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> roith 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 />