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Burnett County . Office of Zoning Administrator iu 0 0 <br /> APELICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '' H i� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e <br /> Ordinance, SanitmTation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a- 6 <br /> Ti <br /> .............................................. .....�!M4R.1 QV.S.'... CA2 i......... o <br /> OWNER (Please print) CONTRACTORJr SURVEYOR or AGENT o. ir' T <br /> R... ke <br /> LU C. .:. ...�!?.ts.:........s. 853 �... WI S. 54830a : t <br /> Ro......�a.!...................... ..................................... .. .!........ .x....6.7..9................................... . <br /> ADDRESS x ..................................... ADDRESS <br /> r <br /> ................ <br /> ADDRESS r ....... .......... ADDRESS :J �l <br /> `1.7 •-, ya.$......0a `I7z -zoz.0.............. 8.�6..- lti.o.$.................................... <br /> ........ i6 <br /> PHONE PHONE :C <br /> .......igi............................................................................... ......................................................... <br /> .........................I......... \ - <br /> PLUMBER WELL DRILLER 2 E <br /> O <br /> ADDRESS ADDRESS.................................................................. m 0 <br /> 0 O <br /> c <br /> ........................................................................................... <br /> . ..........................................................................!.......... O �+ <br /> PHONE PHON....... E Z H <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: y 2. New Building Details No. Bathrooms �....�.... '� o <br /> New Building ..... Type of Construction: No. Bedrooms ,. .L.. <br /> Addition .,,,4.QG....k.R.Al?.�.......... ...... Septic Tank Size Gals. ...su. <br /> Sanitary ... .. Size .... y.... ft. x ....1-....... ft. 'p........ <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingArea Soil Type ....................... .......... <br /> ........................................... i r <br /> Mobile Home See Slope ................................F......... <br /> Privy ,,,,,, ,,, 3. U (describe exact) 1 -fami eTrench <br /> Well .. ... ho ,garage, motel, etc..)) SeepWell <br /> t......... '• <br /> Subdivision .=....�'.Q...PA.'.'.F�' eep ate ......................... <br /> �.......... a� <br /> --Camping Unit .......... ..T{N ..TTIn!.�. . Privy .. i(r <br /> Seepage <br /> Se-- a Bed �4.— <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. Include road <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 LABETING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> C <br /> J o <br /> — — — — — ---- --- — — <br /> — — ---- ----- -- -- ---------- — ---- --- 0 <br /> 5. Lot Size: m <br /> Agsim....... ft. x32.... ft. — .......... ...... s ...........................I �r .�.f..... .......... <br /> "PI, �; tar y � <br /> N { O <br /> O 7 <br /> O 0 tW <br /> E N <br /> -70 s <br /> y <br /> r Z <br /> Zy <br /> suit (l <br /> 30 77 :Emmz <br /> cC 'me c0 6S <br /> m <br /> — a <br /> O <br /> Qt < y� c <br /> �- Z O O m 6 <br /> O O 6 0 <br /> [ ' ,6 <br /> �p <br /> p Z1 198 U� = p <br /> ... . . 1p�Al��y.........,.................. O C <br /> Signature of Owner or Agen /� -1 Date x <br /> U V : M <br /> Rema,IEs „ , <br /> ............................................................... .................... <br /> a^ uInspection Date ................... <br /> Ld 8 8u8'o 8inn 8o 88 cTmn <br /> NOTE: A preliminary site inspection must be made and "tIte 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 plymbing 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />