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.—'t9�77l ca»j.' <br /> Burnett County Office of Zoning Administrator Co 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3 <br /> — <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < u, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis(onsin. _ 0- <br /> .. . � <br /> OWNER (p se print) CONT Ror SURVE R/or NT <br /> .............a . W d .Q..... ... .. ..r . . . <br /> AD .. ..1..... . ....J ................................... ......... <br /> D SSADDRESS <br /> 3}�� <br /> ADDRESS <br /> PHONw�./. �I:)I+�GQ.T. /�.:�i/.✓....... .PHONE...c7<5.�r..G^..:.......(.wl. /.............................. 1 <br /> a/tea �v- <br /> PLUMBER WELL DRILLER <br /> p <br /> .. <br /> ................... ........ <br /> . .. . .............................—.................. . . ............................................................................... .......... _. <br /> ADDRESS ADDRESS 0 G7 <br /> ........................................................................................... ................................................... ............................ .......... a <br /> PHONE PHONE z H Q <br /> DESCRIPTION 4. Sanitar.. E. <br /> Facilities: o ° <br /> """"" <br /> h <br /> Batrooms ' <br /> 1. Work: 2. New Building Details No. o <br /> New Building „ .... Type of nstruction: No. Bedrooms .......... z _ <br /> Addition „�,y�.�q, , Septic Tank Size Gals. .......... <br /> Sanitary ,,,....... Size .� ft. x ..p(�.�..'.. ft. <br /> FilungiGrading ... ...... Height,/Z .... tories ........ 4a. Absorption Field Site: <br /> .. a,. ...�fA..,�r.. Soil Type ......................... .......... 1 .0 <br /> Moving .......... Area <br /> Mobile Home <br /> Slope ............................... .......... ,.. <br /> Privy .......... 3. Use (describe exactly, 7 -family Perc. Rate ........................ .......... <br /> Well .......... home„Barage, motel, etc.) Dry Well .......... 11 t <br /> Subdivision Q�Qrrr��r Seepage Trench .......... ' <br /> .......... ..... .......... <br /> —Camping Unit Privy .......... <br /> Seepage Bed ......— � N <br /> ------------------------------------------------------- --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig- A_ Inclu e road Q $� <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 EX STING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ___________ ___ 1 :Z <br /> 5. Lo S e: / Fig. A. 6. Location: <br /> .�. . ft.t�-p ....Oft. - $�.6 rU.:7D�'sq. ft. ....... .......... <br /> 7"1 d 0 <br /> o <br /> 0 <br /> / �;✓, Ca5S+" <br /> y` s O�Fr/aai� z <br /> 7� Nr v wr <br /> n ty rTa < m 2 — F <br /> N <br /> < <br /> 6 !n0 <br /> N <br /> O _ <br /> O y n <br /> 0 . <br /> 2 O O n � <br /> Ce <br /> �9 Jj <br /> .. �o <br /> ignatu ca6.ner or Agent ate <br /> Remarks . ... ..... / ......./.T..'f'A.. k... . 1f ...Dr.. /.4- 1� ....f��. ............... ......... <br /> ✓Q�^�.r�.....1�s... 4c..rl.....raS. STr6S5i G... dT..'04Wl/ . .. ..Qlr�- <br /> It <br /> ......................................................................................................... ....................... ... .. . <br /> Inspection Date N ro o o l o <br /> ....................................... .... ..... ... . ....... f.(f!U-. . .. . .. ..�.:. .. .... ...... N u, o �n cn <br /> C�.. . Zoning Admi is rotor 8 8 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilitie. <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatl n test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any p umbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the iformation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not Ife made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />