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C-/ ,--V-77 C.-C77) <br /> Burnett county Office of Zoning Administrator d -o0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITt. -. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- ,n -., .t; <br /> >hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m2 oQ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. fl <br /> J�� rr l4rry,,,..,�.�t fr.. ..,er' 1. J.>S' H <br /> .S1 0 <br /> O NER (please print) CONTRACTOR or SURVEYOR or AGENT a ._ <br /> r�- No d/¢it si flu � a A <br /> 4DDRESS ADDRESS _ <br /> co r7 a 4. C oh 1 • S-r nr 0-- <br /> 4DDRESS ADDRESS • <br /> Cr',ell 1 <br /> DHA5IE PHONE -....1., <br /> 1$ekiAs <br /> LUMBER WELL DRILLER s, <br /> ADDRESS ADDRESS 'I 7D G) 7 <br /> 3 PHONE PHONE <br /> z N r pi <br /> DESCRIPTION <br /> 4. Sanitary Facilities: P � ° Er, <br /> Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construet n:. No. Bedrooms .2____ V <br /> Addition "- .)C' S / th q Septic Tank Size Gals. <br /> rt <br /> Sanitary X' Size ft. x t� ft. 7'S:0 0 <br /> Filling/Grading Height Stories 4a. Absorption Field Site: :tip c <br /> Moving Area Soil Type 1. G o <br /> Mobile Home Slope ry, <br /> Privy 3. Use (describe exact) 1 -famil Perc. Rate N - <br /> Well Dry Well <br /> „�C,,,, home,garage,motel, etc.) CZ <br /> Subdivision Seepage Trench e <br /> Camping Unit Privy ® ® 7 <br /> Seepage Bed !.i'j'n-90 <br /> T <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> c� --- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- \ 'G - - <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING , G �• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ` y ' <br /> 5. Lot Size: Fig. A. 6. Location: O = <br /> ft. x ft. - sq.ft. W o <br /> 3 <br /> t Do --- C <br /> _. <br /> to <br /> z <br /> U <br /> o <br /> z k0 <br /> • Do <br /> CD <br /> CD <br /> ei.— m <br /> rif ,,,. <br /> ,. <br /> 7, for rn . z <br /> c w CD c c <br /> m Ep Q a -. o f <br /> • N 01 • co <br /> �. U1 Z w -a 7 c <br /> H• : <br /> Z b o' a. 7m <br /> 70 <br /> o z am _� <br /> O z • —I <br /> v is 7 — e- Pf (li <br /> m <br /> CD <br /> Signature of�sO�w r orAgentDate C <br /> Remarks ..;1„(. ......Z C-- c`-• � c T X m <br /> CD 0 <br /> CD <br /> Inspection Date 7-A2- —g./-1/ o o co o cr m <br /> Zoning Ad inistrator ,p 000000N <br /> JOTE: A preliminary site inspection must be 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 />