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. 7 <br /> Bwrnett Bounty a Office of Zoning Administrat �/ 'for z <br /> APPLICATION F-OR SANITARY — LAND USE — BUILDING PERMIT R. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- y o SU <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c `� <br /> Ordin nce, Sanitatio 'Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. <br /> >- 64- . b./e4r7Z, ft4 r tZC; it o�O-Da — <br /> f0 <br /> OWNER please pr. t) CONTRACTOR or SURVEYOR or AGENT n CD <br /> Cm - Rr Pox' 47 �yr . e�nv d si -- <br /> ADDRESS ADDRESS dear re °7 <br /> ...,a t 1 ti <br /> SPod r. f pi,r, TVA/ 5l7a. W qs .st V <br /> ADDRESS ADDRESS may,,, 1 <br /> PHONEss <br /> bi -f44/ Ac u, ,.: /Il 6547 , `� H. <br /> PHONE '� <br /> , F �7IDfoieco )u `�1 v. <br /> PLUMBE' WELL DRILLER �� to <br /> W►I� ' <br /> ADDRE.S <br /> ADDRESS NCI (7) o <br /> 6:..r'-xr? 'C 4 <br /> PHON: PHONE C <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 1. Work: 2. New Building Details No. Bathrooms ...1..... `k 17 <br /> New Building X Type of Construction: No. Bedrooms a. VTR g <br /> Addition Y1°,gr+f Septic Tank Size Gals. .24 .. 6\ <br /> Sanitary A.. Size a4... ft. x ...A. ft. `Np <br /> Filling Height ,,' Stories /-i. (CL&)a. Absorption Field Site: J ) <br /> Moving Area ...7d'4 Pr; Soil Type o m <br /> Grading Slope h <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate O S <br /> Privy home,garage,motel,etc.) Dry Well93 Su <br /> �{{ <br /> Well �( epe1if Seepage Trench y <br /> Subdivision Privy <br /> Seepage Bed k <br /> --c-- c) cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road , g 3 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- cj '`` . <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O <br /> t.1 o' <br /> 5. Lot Size: 1 6 =eVk i'} <br /> Fig. A. 6. Location: O. <br /> Ac! ft. x �.7 * ft. - ...3 af sq. ft. Or .z,, G'd7- 1-41 3 3 -OD'iy C i. : ' <br /> N C.d O. <br /> Z. <br /> o g, i <br /> 1 ,-7------ --- M�� " id <br /> o <br /> '�' 1 � 3 <br /> s �s `�, ,.... ...,‘ G ri, <br /> wX a 73 <br /> z <br /> _Th <br /> a" <br /> / <br /> CD <br /> Syr,, l � �° �� , ��. . <br /> J ift _ ..- <br /> 1241 "a cn '�'<: C 30 <br /> 1 z O N a' to S, <br /> Liu ED, <br /> S. ture of Owner or Agent Date o C <br /> — <br /> Remarks e/fr'(�l/ / --or-"' AI m x m <br /> ens k <br /> Inspection Date 7-ir " ir4l. 9a.irbo <br /> �c`.! ke, <br /> c qn•.o 8'o 0 m <br /> Zoning Administrator o o o o 0 o y <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilitiesss <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig 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 />