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rl'7 7--) .-e--7,^7 t <br /> Burnett County Office of Zoning Administrator cn a H 0 <br /> D <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 •- H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ( c (('\ <br /> cD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ,s� • IfT S lift`//Y�Sri?e A/ H <br /> OWNER,,jplease print) _ CONTRACTOR or SU VEYOR or AGEN,,T��// Az, 0 ci <br /> ADDRESS// °r* <br /> c Z�t/ ti ADDRESS <br /> MAI 6`^6c/4 a , <br /> ADDRESS ADDRESS N <br /> s k. <br /> PHONE PHONE <br /> en \J <br /> PLUMBER WELL DRILLER <br /> v <br /> ADDRESS ADDRESS ro 0 <br /> n o <br /> '. <br /> o ,-: <br /> PHONE PHONE <br /> Z H r <br /> DESCRIPTION 4. Sanitary Facilities: /, P o ° <br /> • <br /> 1. Work: No. Bathrooms v <br /> 2. New Building Details o ( , <br /> TypeNo. Bedrooms ` -c <br /> New Building <br /> of Construction: t CD <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size 'y ft. x ....y.`./.. ft. <br /> Filling/Grading Height Stories / 4a. Absorption Field Site: <br /> Moving Area G4c(.1 ��+d<`-":—' Soil Type o <br /> Mobile Home Slope r* <br /> Privy 3. Use (describe exactly, 1 •family Perc. Rate S3 <br /> Well home,garage, motel, etc.) Dry Well <br /> SubdivisionJ d. L C Sa j�Li/7Seepage Trench <br /> tii <br /> Camping Unit pa/ 4",r/57/4./o Cr Privy <br /> 139sE7��t,� <br /> Seepage Bed ;.r, <br /> I c <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- .. Q <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. ti <br /> n O. <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. <br /> CD <br /> Cl <br /> -. <br /> N O <br /> O 0 <br /> 5* w <br /> O �\ <br /> u1�1/ H <br /> / i i <br /> 0 <br /> Cyto <br /> � � <br /> Do <br /> Do <br /> aio <br /> ai <br /> NN <br /> 7) C/1 r- * � coZ <br /> cp N Q CSC all' <br /> — a <br /> "O cn < y ,5 co c <br /> /(/ o /NC � �/4s6r z © 5 Dam <br /> M o• , <br /> a <br /> — g <br /> 1g pto eemS. o o : <br /> fi 1 <br /> m <br /> Signature of caner r Agent 6Date/ g J �I ,- p <br /> 77 <br /> Remarks ..j4� .: 37 6 -, m <br /> CD CD <br /> v <br /> Oa <br /> Ot <br /> �° r71 <br /> n <br /> Inspection Date ???�/l o o cn o cn o cn <br /> N co N m <br /> m <br /> Zoning Admi istratorA' J 0000Obbbooy <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> aefore 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 />