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Burnett County Office of Zoning Administr itor Iv $ c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 9 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and �2 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the m <br /> Burnett County Land Use Ordinance, S tion Code, and with all other applicable County Ordinances and the laws and 3 & � <br /> regulations o�f,tt1 a State pppjjj Wisconsin. <br /> //i7���5 O c C //C — n <br /> ..........�.............................. .......l/ <br /> OWNERlease riot) .................................................................................... ....... <br /> OWNER P CONTRACTOR or SURVEYOR or AGENT ]� <br /> 1 ../.. S/.....J-9 1 ............................. ... . . . . . . <br /> ADORE ADDRESS <br /> . ....... . ...................................................... . . ...... . ....................................................................... ....... i <br /> ADDRE ADDRESS <br /> /a..-.. .-5!11............................ <br /> PHONE PHONE <br /> ........................................................................................... WELLDRILLER <br /> PLUMBER <br /> ......... ................................................................................. . . ...... . ....................................................................... ....... O <br /> ADDRESS ADDRESS C <br /> _. c j <br /> ........................................................................................... . ........................................................................... ....... N » <br /> PHONE P..HO....N..E Z <br /> DESCRIPTION 4. SaniX <br /> cilities: ° o <br /> 1. Work: 2. New Building Details No. ours <br /> No. ms <br /> New Building Typ f Constrt�ctlpn: $ <br /> .......... .. ....... <br /> Addition y A � SeptSize G i <br /> .......... Size '..ft'.x........ ... ft. <br /> Sanitary /..- u_r�.': .. .. .. ....... <br /> Filling/Grading4a. AbsF I Site: <br /> .......... Height........... Stories ....vz,.y.� <br /> Moving Area ��'r....... :/.."Z. Soil ..... ................... .. r.......... ........... ......Mobile Home L/ Slop.......... .. ....... ................ .......Privy .......... 3. Use (describe exactly, 1 -family Perc ............ ............. .......well ,.,,....., home, ars e, otel, etc. yo <br /> 9�r� Dr .. ...Subdivision .......... 411p= iOQ/,. wt'�w Seepnch .. ....... o..............................Camping Unit .......... ... Priv .. ....... � <br /> .................................................... Seepage Bed C7 <br /> ----------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. : r <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca d at w <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i o <br /> ----- --- _—_ --------------- ___------ -- ° <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ...................................................................... ........ <br /> n <br /> N O <br /> O 0 <br /> DI/a��1I�C <br /> til'C 111 o <br /> ti <br /> Z 7 <br /> a <br /> M W 'D W 1 $> Co a <br /> nwa < > > n - - m <br /> m y > > 3 <br /> D 0 y : `G 41 fp ,p <br /> o N a <br /> „ a : y <br /> m <br /> a = SZZ� <br /> C <br /> m � <br /> ..... ........ .......... .................. ...................... ... <br /> Signature of O ne or Agent Date <br /> Remarks ...... ../ ... . �.. ...�� .... .r.[�:i-�-.,h..�G. 2.��n: /..aux. ........ ,°m, a <br /> .• �. <br /> o0 <br /> Inspection Date ro m Npoo <br /> m <br /> ZoningAdminist at r 0 0 mNOTE: A preliminary site inspection must be made and site approvalgranted on all structures involving sanitary fa ilities before constru <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />