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-- / (541 Crali)1 <br /> Burnett CountyOffice of ZoningAdministrator iv z <br /> 3 - o ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT .' g. o <br /> ro THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N -' <br /> Ihown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Jrdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a Cl\ <br /> r" a <br /> 0 <br /> B. 5 Co.t/s7' c75(1/ H a <br /> JWNE�R (please print)inCONTRACTOR or SURVEYOR or AGENT a Q;� CD <br /> S /i°4 f" " 1 .S p c,eD tV 4P Y- S 4 SVd/ F�� <br /> E: <br /> ADDRESS ADDRESS <br /> ADDRESS ADDRESS �Q �J\ <br /> 'HONE PHONE C\� (...\G• ‘.../ Lt./ 'Pr4u /Son/ C - S C <br /> 'LUMBE44 cyte,., WELL DRILLER <br /> V/3 SA4 iT S> Spo0fl/Ql- pNt, 0 <br /> ADDRESS ADDRESS ; G7 <br /> . s` -- - '/ T 7 <br /> PHONE PHONE Z h .. <br /> DESCRIPTION 4. Sanitary Facilities: ° o 9. <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building 4,--- Type of Construction: No. Bedrooms i <br /> Addition Septic Tank Size Gals. `7..9..x?. v <br /> Sanitary Size ..' '1 ft. x -`/ ft. <br /> Filling/Grading Height Stories J 4a. Absorption Field Site: <br /> Moving Area Soil Type r- <br /> Mobile Home <br /> Slope o <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate I <br /> Well home,garage, motel, etc.) Dry Well ..S <br /> Subdivision C 73/4/ Seepage Trench LI,, k. <br /> Camping Unit Privy <br /> Seepage Bed =( <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road 0 <br /> 0 c <br /> IN.- <br /> setback, side and back property g a <br /> yard dimension and location and setback from all bodies of water. Ifis located at a highway inter- i fl- <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. o' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> / )'-- ft. x L//v ft. — sq.ft. AIA %y,t(w/Ai, 3°e,•7--1 A / ;ro Bila/v k/ M Z <br /> 0 <br /> cn <br /> LI ccg <br /> N 5. <br /> 0 <br /> 7 <br /> un <br /> t7 �1 <br /> r-r <br /> o <br /> n- <br /> X5 -o <br /> T q <br /> v <br /> CDZ <br /> 0 <br /> N <br /> 0 <br /> cm <br /> Co <br /> *. <br /> o *A. <br /> cr C <br /> — dn) a < 7 <br /> °-o n < �, mrFy• m <br /> Z o 5 <br /> D <br /> ° • <br /> o a , 3 <br /> o o • <br /> 6�\0 70 <br /> " .":11 <br /> .. � m <br /> i /> �j 0 <br /> signature of 'owner or Agent ate — <br /> Remarks . 29‘ C. m 0 <br /> ::14t <br /> \ II <br /> . OGS <br /> �� -.- -472-,-- -0.2.) <br /> T <br /> Inspection Date 7'a2 7— l r t .... . - I . o 9 o 9 o m <br /> Zoning Admi Istrator /c✓ 0 0 0 0 0 0 N <br /> JOTE: A preliminary site inspection must toe made and site approval granted on all structures involving sanitary facilities <br /> Before 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 /> vith 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 />