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3urnett County Office of Zoning Administrator c 1 0 0 <br /> 1 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> -O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as •<' <br /> 71 hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m H ...4 C <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 7g60/ 163A/Lat. 4t. '' o- O <br /> we / � a � � Qs cD <br /> )Wf�fER (please pint)int) CONTRALTO or SURV YOR or AGENT acD <br /> D rG.1/ b iOt i Lu i...0 • 1-- � Q <br /> ,i ' <br /> ADDRESS ADDRESS ` <br /> • <br /> .DDRESS ADDRESS 4 ^, i6 <br /> ,HON PHONE <br /> \ '� <br /> 'LUMBER WELL DRILLER ``p O Ot <br /> ADDRESS ADDRESS CD o <br /> r+ < <br /> O .+ <br /> PHONE PHONE z - <br /> DESCRIPTION 4. Sanitary Facilities: o o <br /> 1. Work: No. Bathrooms o �88 <br /> 2. New Building Details <br /> New Building Type of Construc�tion: No. Bedrooms X1 fD <br /> Addition .. 9 V/ S /! Septic Tank Size Gals. 6' <br /> 74 <br /> Sanitary �— Size ft. x ft. V <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type .0... . .--q.D... ........ o <br /> Grading Slope fr(......... 4 h <br /> Rate <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. ,� <br /> Privy home,garage,motel,etc.) Dry Well ` <br /> Well Seepage Trench + to1 <br /> Subdivision Privy -Z 6, <br /> , ‘+; <br /> Seepage Bed 11 <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road R tT <br /> TIT <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- j- ^ a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTIN4 r� d <, A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. • -Z. P 3 <br /> i ei <br /> 5. Lot Size: Fig. A. 6. Location: L '�71— rrt <br /> ft. x ft. — sq.ft. :r . <br /> ., <br /> r10 <br /> • <br /> co <br /> l'epLa8 it,..4 svxk, 6 N _b r <br /> s ww _. <br /> r ...., <br /> IX1.3roi . y <br /> H. t, ° <br /> X.) �. <br /> T <br /> z <br /> oNk. <br /> (11 1.. . . C <br /> CD <br /> 73 Cr) r � CO <br /> N. r-Cr 0-< 0 <br /> -o alZ.0 3. 0 m <br /> Z oo'm col ' fD 71 <br /> o = <br /> 5 <br /> 3 <br /> Oa' `o _ <br /> --1 <br /> XI <br /> a m <br /> 2Sci-A:-' ' •� F' -.I <br /> -- c <br /> Signature of Owner Agent Date X IA - <br /> Remarks m . p <br /> b\ II <br /> tk <br /> (A <br /> 0 <br /> T <br /> \a o 0000c^'nm <br /> • <br /> Inspection Date9 ,ra.. ..„ j o0ogoocmi� <br /> Zoning Admini trator <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />