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Burnett County Office of Zoning Administrator �n - --I 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < �7 :43 <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 /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> m ?ty O <br /> d................................................... .......Jo.e...M......Jami.s.G-n.............................................. 6 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. ( r0 <br /> ADDRSS.U.L1...SU............................................................. .ADDRESy.W.15......5.4H. .a............................................ <br /> N. <br /> ,i.n.8....I.1.i.,....61.ab.5.......................................... . .......................................................................................... <br /> ADDRESS w <br /> ri <br /> ADDRESS ADDRESS � ?� <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE <br /> \ I x <br /> .....Jo.f:...kl.......I.ama.s.R.n.-Si>;.z.n............................... ....a.a.a...M......,I.amz.s.an-.S.i..r..en................................. <br /> PLUMBER WELL DRILLER rm <br /> iv <br /> O M <br /> . . . . ............................................................................ . . ...... . ............................................................................... m <br /> ADDRESS ADDRESS :V` 0 'x <br /> 3.4.9-5.6.22...................................................................... ............................................................................................ \ o o a <br /> PHONE PHONE Z N <br /> DESCRIPTION 4. Sanitary Facilities: 0 6 0 <br /> 1. Work: No. Bathrooms 1.......... l <br /> 2. New Building Details o <br /> New Bulldin XXXX T No. Bedrooms <br /> 0 ..... Type of Construction: 2"""•' Iv , <br /> Addition new—frame f,rame,,,,,,,,,,,,,,,,,, Septic Tank Size Gals. ...7.54 i ' <br /> :O < <br /> Sanitary ..XX•XXXXXXPke .....2.4.... ft. x ....36..... ft. ......... m <br /> Filling/Grading .......... Height....$...... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .........gSoil Type .................................... <br /> FT <br /> .......................... r? o <br /> Mobile Home .......... Slope .......................................... ry C <br /> Perc. Rate ................................... <br /> Privy 3. Use (describe exactly, 1 -family , <br /> x <br /> Well pa J..R.(l.. f or home,garage, motel, etc.) Dry Well .......... 3 <br /> Subdivision .......... Seepage Trench .......... <br /> .... ............................................... ^£ <br /> --Cam <br /> CampingUnitPrivy ..... .... <br /> P 9 .......... ..7....�.aAl].�.y....G O.Z.z.a$s....... Seepage Bed <br /> �Fi1y 24�£ <br /> C <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING LU -Pt <br /> n <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ______________________________________________________________________ i y 0 z <br /> 5. Lot Size: Fig. A. 6. Location: C" <br /> 100.............. ft. x ..20.0..... ft. —24x0.o ................... sq.ft. W Baes....Lak-e....Rao-a.d....................................... <br /> w ' <br /> W P <br /> 0 n n <br /> t o on <br /> N to :4 o <br /> � o d 0 <br /> 3 N <br /> SEE ATTACHED SCHEDULE v� 0� <br /> J --I <br /> O C 0 <br /> rr <br /> to <br /> � J G b � <br /> In ZOO :O <br /> d <br /> in <br /> r <br /> m <br /> ;J <br /> or <br /> E <br /> or m 1u <br /> aw <br /> Z O O m n a <br /> 0 n 3 <br /> :W rFill <br /> 31 <br /> ....):1114 <br /> ........��....... ... ��..�'!'�' ....................9.).1.7 .8.5 - c <br /> Sige off Owner or A an l Date ° — <br /> Re ..G(i.� .. .. e<.Fi �. �ls-a-� .... .S/ 9L .� d / x m <br /> v <br /> �l <br /> n : <br /> Inspection Date ....................................... <br /> ' mam <br /> tratoZoning Ad nisr <br /> v 8 8 8 8 8 8 in <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 marle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />