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cm <br /> 5,--- I <br /> lurnett County Office of Zoning Administrator En 3 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;v o <br /> 0 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N '"' 93 <br /> sown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD e N <br /> Irdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> v <br /> o� D41),grack 51 <br /> N <br /> rr <br /> v N <br /> 0,f,40V,W2C <br /> cp <br /> CONTRACTOR or SURVEY R or AGENT fD al <br /> )WNE please print) 5���y c- <br /> .1Z ' yam, A)/ <br /> kDDRESS ADDRESS m 't <br /> \DDRESS ADDRESS f <br /> 'HONE PHONE 'b <br /> Nk <br /> 'LUMBER WELL DRILLER <br /> C7 <br /> 4DDRESS ADDRESS h 0 <br /> o' :- <br /> DHONE PHONE o h • <br /> DESCRIPTION 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details <br /> No. Bathrooms o <br /> New Building Type of Construction: <br /> No. Bedrooms CD <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> FillingHeight Stories 4a. Absorption Field Site: <br /> Soil Type r- <br /> Moving Area Slope o <br /> Grading Perc. Rate <br /> Mobile Home 3. Use (describe exactly, 1 -family Dry Well <br /> Privy home,garage, motel, etc.) <br /> Well Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed <br /> rn <br /> c <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road Q (\.\ <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- sa. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ,,,• izzt <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. .. <br /> 1�,i cn <br /> s.,,, o CD <br /> i`el• q p, avi - aac uJ ) 5• -N, <br /> o <br /> sp S) F <br /> Ht <br /> 1 I <br /> ( „ �V <br /> z <br /> 0 <br /> �l 7J <br /> CO <br /> 0 <br /> m <br /> r--,. t N <br /> m. NQ0-< —'+' - <br /> -o to <•C -. 5 o -o <br /> 0 1 /, < CO C ITI <br /> Z O S fD : : CD M <br /> ° o um 3 <br /> 00 0 x <br /> �C rr <br /> y is-�Y �o <br /> Signature of Owner or Agent Date X 7 <br /> Remarks `T° Kt IT <br /> C <br /> t <br /> Li ii <br /> tiit le <br /> _Efl <br /> 907,zio °v1 000 0 0 0'i, RInspectionDate � 10 bbbbbbR <br /> Zoning Administrator 4-"✓ 0 0 0 0 0 o v <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 />