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.. <br /> �) ! ( (%, f <br /> �,iltt County Office of Zoning Administrator Cl) - o', Z <br /> -` * o <br /> ` 'APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 94 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< 7 -h S�j <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C c : p�� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a v\ <br /> v <br /> 0-a1-1 4 O <br /> , <br /> a �ji C <br /> OWNER please print) CONTRACTOR or SURVEYOR or AGENT a. Cs <br /> ADDRESS ADDRESS °,.+' d <br /> ah rts <br /> ADuHESS ADDRESS T <br /> PHONE PHONE <br /> At(0 l 'n 16—e t—p•Or . ,,, <br /> PLUMBER WELL DRILLER -N, \ CT) <br /> l,O. sr N o <br /> ADDRESS ADDRESS <br /> (- 6j°S7' ° <br /> PHONE PHONE z • <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: / P o (2 <br /> 1. Work: 2. New Building Details No. Bathrooms � 7 .' <br /> New Building T pe f C nstr cion: No. Bedrooms ... .. '1 m �') <br /> Addition ,Q61,�-�„ ,,, ,Q7yl e Septic Tank Size Gals. -]..,.0 k <br /> Sanitary X Size ......ff . ft. x ..a'..Q.... ft. p <br /> Filling Height Stories 4a. Absorption Field Site: <br /> kli <br /> Moving Area Soil Type SQ'/Z L I— <br /> Grading _ Slope ,_ <br /> Mobile Home 3. Use (describe exactly, family Perc. Rate ....3 - 3- 3 <br /> Privy home,garage, motel, etc. <br /> Dry Well I <br /> Well Seepage Trench — • <br /> Subdivision Privy ,i-, 7,Z1 <br /> Seepage Bed x. rA <br /> 3z cn <br /> c <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- a _Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ) _I" <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 5' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. - sq. ft. <br /> // LI A-(/ S <br /> cp <br /> N O* <br /> o m <br /> D <br /> 5' r- <br /> 0 r+ <br /> o z <br /> o <br /> z <br /> i b. m 7... . <br /> co <br /> (V2 0 <br /> o <br /> e um <br /> >� o <br /> CI <br /> cp _ � _. <br /> CC• NQQ•G '-i - * <br /> o N H < * rn <br /> Z oo' m : fD 70 <br /> o : <br /> m _ <br /> ��,, 01 co � <br /> V O <br /> /( <br /> -/-M-FY b <br /> rrl <br /> Signature of Owner or Age Date <br /> Remarks -n x i m <br /> co o <br /> u o <br /> � <br /> Inspection Date ' '9� o 0 0 0 0 2 m <br /> ZoningAdmi ' tr 000000fm/) <br /> JOTE: A preliminary site inspection must he made and site approval granted on all structures involving sanitary facilities <br /> lefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will he 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 /> iith 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 /> ✓ <br />