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3urnett County Office of Zoning Administrator a, -o 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 7.. 3. <br /> O <br /> .O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H -. <br /> gown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m O <br /> )rdinance, Sanitation Codee,,and with all other applicable County Ordin ces and the laws and regulations of the State of Wisconsin. B n. r <br /> co)I i of /4? aeregiel — C <br /> )WNER (please print G6G CO TR OR or SURV YOR or AGENT e fD <br /> C. <br /> 1DDRESS AD RESS _ C <br /> .. Gl '/ 5 y17•: <br /> ADDRESS ADDRESS <br /> 'HONE PHONE <br /> 'LUMBER WELL DRILLER <br /> i...- <br /> q <br /> ADDRESS ADDRESS n 0 <br /> ,-, < i <br /> o ,-,- <br /> ,HONE PHONE z 7 • <br /> DESCRIPTION 4. Sanitary Facilities: o o o <br /> 1. Work: 2. New Building Details No. Bathrooms 3 <br /> New Building Type of Construction: No. Bedrooms CD <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type �°m <br /> Grading Slope . <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate -1 <br /> Privy home,garage, motel, etc.) Dry Well 'f. <br /> Well Seepage Trench °O <br /> Subdivision V Privy *Q <br /> Seepage Bed <br /> (/J <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road - ell <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- O: <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ,<-„• 0 <br /> A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 3 <br /> 5. Lot Size: Fig. A. 6. Location: E <br /> ft. x ft. — sq.ft. <br /> 0 <br /> m <br /> zz, 57Y) {� N O <br /> (7 7 <br /> 1 <br /> l�+ a� % l d 0 I1 <br /> r L rt <br /> �U ':0 0 <br /> fur1 H <br /> T Q <br /> z Z <br /> o <br /> 1 <br /> J <br /> MI <br /> Z. <br /> -r . x, cnr -o*cnooz <br /> C s < g <br /> m a < — '+a <br /> °� -I .. d 5 0 -a <br /> •< <a m <br /> z o 5' : : fD 70 <br /> o a <br /> 5 <br /> at CD <br /> s/ o 70 <br /> 9- /7 ' F'7' CA CT C <br /> Signature of Owner or Agent Date '� — <br /> X 70 <br /> Remarks 3s p <br /> W ii <br /> Inspection Date �77Ze4 / - 1.�*� � G' 0 0 en 0 0 O m <br /> Zoning Administrator o0000ov) <br /> VOTE: 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 plumping or start any build- <br /> ng 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 />