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�� ' ,( -Y/1f,', <br /> Bu.:nett County Office of Zoning Administrator c I o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. 3 <br /> 5...TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 0 <br /> ohown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Jrdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 2 a <br /> iosepl) o (39.4kizz j1.0,4-il (_: . V a p a--1-1 7 ,94. <br /> N a,JWNER (please pr t) CONTRACTOR or SURVEYOR or AGENT <br /> 8_ t a, <br /> 4DDRESS ADDRESS f ,°7+ <br /> CD <br /> 4DDRESS ADDRESS N. <br /> 'HONE PHONE <br /> Ni <br /> 'LUMBER WELL DRILLER v <br /> P. <br /> DDRESS ADDRESS (13 C) <br /> r) o <br /> 'HONE PHONE z <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building Type of Construction: No. Bedrooms to <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type <br /> Grading Slope 0 0 <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate O <br /> Privy home,garage,motel,etc.) Dry Well t <br /> Well Seepage Trench s <br /> Subdivision e/ Privy W <br /> Seepage Bed <br /> _ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road I c <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- rr1 0 <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING l' <br /> >TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. H <br /> I g <br /> 5. Lot Size: Fig. A. 6. Location: >^ <br /> Z. <br /> ft. x ft. — sq.ft. .--7 <br /> t' <br /> CD <br /> 9_1" & r,acjad d 31)) 0 <br /> o <br /> \col. 0I p.. . )3 5. <br /> 0 <br /> r-F <br /> CO <br /> G <br /> v <br /> N T <br /> t� W d <br /> z <br /> 0 <br /> • Do <br /> m <br /> CO <br /> CD <br /> 1 <br /> m C r- �*d CO Z <br /> cp C CD <br /> m No_ < - . a <br /> 0 cri▪ b �< <n � m <br /> 05•m : : fD MI <br /> `0 0 <br /> Y//d A957 .Ni• 1C7)D i <br /> signature of Owner or Agent Date ° — <br /> X 70 <br /> iemarks -t m <br /> CD CD <br /> v <br /> 69� V <br /> II <br /> - TI <br /> nspection Date D. 1, o 0 0 0 0.tt' m <br /> / Zoning A <br /> Ad lnistrator�d o 0 0 0 0 o N <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> !fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />