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r <br /> Burnett County Office of Zoning Administrator c - --1 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v c. <br /> 3• o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 1.--1-, Lx <br /> Chown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ro \ <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> jj °- .•i <br /> O <br /> J. Winchester ae . GUtJ H h c <br /> 4 <br /> c <br /> OWNER (please print) CONTRACTOR r SURVEYOR or AGENT <br /> cc, <br /> POBox 132 55 Billings Dr. Q , ,,c-,i) <br /> ADDRESS ADDRE S co <br /> Superior , WI 548E1] Gil/ y1.1> ,,) <br /> ADDRESS ADDRESS <br /> 392 1058 b •U <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS CD <br /> h < <br /> F. <br /> O ,: <br /> PHONE PHONE Z v, • <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: •0 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details L, <br /> New Building Type of Construction: No. Bedrooms co <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 o <br /> Grading Slope <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Subdivision x.x.... Privy <br /> Seepage Bed <br /> cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road a- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 0- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING N• <br /> A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> c <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. <br /> 1 <br /> 1.1 \ cn <br /> 3-a..) i e 5(l) a <br /> �J C) <br /> N O <br /> o = <br /> �, Paro <br /> ,--=. -,• <br /> z <br /> r'-` 0 <br /> CD <br /> 7 <br /> CID <br /> Do r7gmmz <br /> fD C 0 _. ry N C cr, <br /> _ 7 <br /> cs• a • .G — '-r d <br /> -a- < °' 5' 0 11 <br /> < co * m <br /> z oo' . : m xi <br /> O n <br /> 1' lc.=Zt c, ,s lie- Jan. 1 6 t 1984 41.61 v�cI 4 -' 7 y a-/-1, ,q - m <br /> o C <br /> Signature of Owner or Agent Date <br /> X a3 <br /> rtemarks m - m a <br /> CD <br /> W ' <br /> I� 4 Inspection Date9.2.7,-a‹,./2 y%> <br /> 0000om\� 00000 .. <br /> Zoning Admi s FI /)NOTE: A preliminary site inspection must he 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />