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3urnett County r Office of Zoning Administrator ? c" 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> 0 <br /> fO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cca <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a N - <br /> 5+p(,N D,4 L 0 <br /> ( S6 (-F y h 0 <br /> 0 7 <br /> DWNER ( lease print) CONTRACTOR or SURVEYOR or AGENT m ` <br /> 4DDRESS ADDRESS v <br /> D�wt-t , MA., 2, 8 ( -1- tt,,_% <br /> D RESS ADDRESS <br /> �1 <br /> 21g ' z`1 <br /> j2V — Z8 <br /> 'HO N..E PHONE <br /> 'LUMBER WELL DRILLER <br /> O <br /> 11)%,., <br /> ADDRESS ADDRESS C) 0 <br /> 5 < <br /> PHONE PHONE z oy <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms 0 <br /> New Building ..,. Type.of Construction: No. Bedrooms CD <br /> Addition ( d) Septic Tank Size Gals. <br /> Sanitary Size IL. ft. x ....../.U... ft. <br /> Filling Height 7 ' Stories I 4a. Absorption Field Site: <br /> Moving Area Soil Type <br /> Grading Slope o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc. Dry Well c+ <br /> Well — ! Seepage Trench , <br /> Subdivision "tt Privy <br /> • Seepage Bed , N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road N. 6 <br /> M <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. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING , y• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ,,J,i o . <br /> 5. Lot Size: 3 ? AciZ r c Fig. A. 6. Location: s` <br /> n <br /> ft. x ft. — sq.ft. <br /> Cl, <br /> CD <br /> C) <br /> N O' <br /> 0 7 <br /> 5' <br /> CO <br /> 0 <br /> to. <br /> 0 <br /> C <br /> V 7 <br /> I! <br /> .``N a. <br /> t T s . <br /> z <br /> p. 0 <br /> i CI <br /> MI <br /> n <br /> an <br /> m <br /> !r NO \ <br /> d <br /> G'.7 <br /> Y � •• z <br /> cD C d m <br /> `cp...., <br /> Vl'tis �1��n J� '� C0 6- 7 < N 7 <br /> m, N d -•< — r • <br /> cn < c a' 0 'D <br /> h o y N * m <br /> z o o' 0 fD 70 <br /> 0 7 5. E <br /> /� °D o �p <br /> \ �`� m <br /> Signature of wner or Ag nt Date o C <br /> X 70 <br /> Remarks CD p <br /> O II <br /> VI T7 <br /> 4 00000c0 m <br /> Inspection Date 000000m <br /> ;2,4,-,..e., <br /> Zoning Admini tratord 0 0 0 0 0 o fn <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />