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Burnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 2. 3. * �. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ' 7 o Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ( c (j <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a 0 `h• <br /> Get A ld f7!1!� Ze..Irr N ➢ o <br /> OWNER (please print) G CONTRACTOR or SURVEYOR or AGENT Q CD <br /> 1...1.0 CO) AA..R.otNe a <br /> \ <br /> ADDRESS ADDRESS CD � <br /> if: rb <br /> ADDRESS 1 550 ADDRESS ? <br /> PHONE /Trent. C. � PHONE <br /> Oa- `l3�- 951 8wpa��ygQat <br /> PLUMBER WELL DRILLER , <br /> 0 <br /> ADDRESS ADDRESS C) <br /> < <br /> PHONE PHONE z u, 1- <br /> DESCRIPTION 4. Sanitary Facilities: . o o <br /> v <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms 0 ,..., <br /> Addition ...X.. nn Septic Tank Size Gals. Z i <br /> Sanitary Size ..A4/;�./. ft. x ....saS.y.... ft. �J <br /> Filling Height....l.. ... Stories ,one.. 4a. Absorption Field Site: , l <br /> Moving Area {{ Soil Type <br /> Grading Slope ( o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate 9.s, +.- <br /> Privy home,garage, motel, etc.) <br /> Dry Well <br /> Well AR.A ,.e Seepage Trench i <br /> Subdivision Privy ...... <br /> Sl.) <br /> Seepage Bed .,. ),) <br /> 1� c 03 <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road 6 _ <br /> >etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q-A <br /> >ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING "-)k) r` <br /> N ` <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ?so <br /> 5. Lot Size: Fig. A. 6. Location: 4 W <br /> .../. .(".... ft. x ..aQ.Q.. ft. - sq.ft. <br /> N0115w LAke <br /> CD <br /> 3., � N o <br /> f3oArt 9J <br /> I <br /> House_ ,...,, <br /> O <br /> 11 <br /> Lo ? <br /> lli 1 <br /> 0 <br /> N. ° . <br /> �s /o .. 2 <br /> Makin/i n/ GARAle- <br /> AnK 's <br /> Do cnr . * c!. mz <br /> �� C tocr = <' m = L. * <br /> �(7� m N Q Q — rh Q l <br /> gat ` o Vt <. C Q'i0 m <br /> ' oN H � � 0 m <br /> Z o o' CD i m 70 <br /> o <br /> �� <br /> %✓fil-RigY1Ge ROA/ o <br /> iD <br /> %..12/1Ailk, R V Y-9- 4./- ” _ <br /> Signature of Owner or Agent N Date '. T.x C <br /> 7.1 <br /> Remarks vvvv m- <br /> CD vi C <br /> te <br /> ' u c <br /> 1 <br /> i ti \� N <br /> Inspection Date ' rL-�; .e, ,' 7 /--,_z-`,2:1,--. K '11 <br /> 0 0 0 o v, m <br /> Zoning Administrator < u 0000 oN <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 /> ug until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> fith 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 />