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Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d' 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N ,� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e :yam <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M ?IN <br /> .........................'T /4c,f!� .So.._.. <br /> 9 <br /> ........................................................................... <br /> OWNER <br /> . 4 444.. ......... ................. .. ......RA GENT m <br /> .... .. �l/.�.�.S�t �.............. S 9 2C S 3 y <br /> ADDRESS lease print) , CONTRACTOR or SURVEYOR or AGENT` a � • <br /> W <br /> ADDRESS <br /> Ul.c..�os ..........w sc S4K93 <br /> ADDRESS <br /> ...................................... .ADDRESS............ . ..... ....................................................... <br /> �. <br /> `..'sbo..."" . <br /> .3 <br /> PHONE PHONE <br /> .td t S <br /> ....... ..................- .................................... <br /> 4444 4444 .. . <br /> PLUMBER � WELL DRILLER <br /> 1�..� .. .. <br /> ADDRESS ........... . ................................................................................ � O 'o <br /> ADDRESS <br /> So 5-!. P.� r►1.� SS0,7 <br /> .............�.L.................................... ................ ............................................................................................ <br /> PHONE P-}�c—L- 370 060 ` Wo"K PHONE Z <br /> DESCRIPTIO ,A ,4,51 4. Sanitary Facilities: o w `tY <br /> C�o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New BuildingType of Construction: No. Bedrooms ...... E g� <br /> Addition x,, „•,•, Septic Tank Size Gals. ..... <br /> Sanitary .......... Size .............6 ft. x ............_ ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .6........................4666............. Soil Type .................................... h4 r <br /> C <br /> Mobile Home .......... Slope .......................................... <br /> PrivyPerc. Rate ................................... <br /> .......... 3. Use (describe exactly, 1 -family Well Dry We <br /> Well ...... home,garage, motel, etc.) "' I <br /> Subdivision ,,,,,,•,,, �, 1 �}o rh` Seepage Trench ....4444.. <br /> .. ............ ................4444 Priv <br /> Camping Unit .......... ..... y .......... <br /> .........................................4......444. <br /> Seepage Bed ....4444.. <br /> ------------------------------------ <br /> Location of proposed structures and existing structures well,sewage systems, roads etc., should be sketched in Fig A. Include road .Q1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter o; <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING - e <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' yy 1 `UJ <br /> H <br /> J�LS_{�w,� J n` J <br /> 5. Lot ize: Fig. A. 6. Location: Ftp <br /> M 52 <br /> .�.. .. ft. x .T14.. ft. — ............................... sq.ft. <br /> a <br /> I: n <br /> 2bk2v o <br /> A-dd:twr� <br /> Q 1 ��Q A�✓� Porscl-4 o <br /> d -34ot} <br /> Q <br /> —� w <br /> D ;-F ; o <br /> Z <br /> 0 <br /> Qoc K vi <br /> ,r +-IO M L � r� � a m Z <br /> n cr < c m <br /> fA n F <br /> or ;c <br /> ZOXZOt oNm ; am <br /> o o = <br /> �nom: 37 <br /> :moo � 3 <br /> .U3 <br /> �i c"o <br /> ............................... <br /> Sign ure Ow gent Date 1 X . <br /> Rearks ... ..... ................................................ y m mm <br /> ............................................................ .............. . . 4444. <br /> L. <br /> ..........................................................................................................................................�0*. ...J.. ...... Fn : : <br /> li <br /> .......................................................................................... ..... ................ .. <br /> 4444 . ................... ... ............................. <br /> m <br /> InspectionDate ....................................... 4444.. 4444.. .. ........ ............ ..........................7......... <br /> Hing Administrator 3CW,.t. N <br /> NOTE: 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 /> 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 />