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49-77GC-7 9c f• <br /> Buciett County Office of Zoning Administrator - o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT fa B. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as G y S.,' W <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. 3 0. <br /> C /(„6 erg' a /�� ' oC <br /> v, ` C <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT cec ri <br /> ADDRESS ADDRESS 4,-- aR� <br /> ADDRESS ADDRESS <br /> *co <br /> i f--. I ei2- j,,Rtridc(37a-gc3j ....4 --.c <br /> PHON PHONE <br /> PLUMBE WELL DRILLERIL 0 it S i l'' st. Lrft17 <br /> D. <br /> ADDRESS ADDRESS c 0 4 <br /> PHONE PHONE z ? '- <br /> DESCRIPTION 4. Sanitary Facilities: / ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type v oons action: No. Bedrooms r <br /> Addition Septic Tank Size Gals. ZZ <br /> Sanitary Size ..a.. ... ft. .42.7... ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area ..4'2/I /. Soil Type - � <br /> Grading Slope e c� H. <br /> Mobile Home 3. Use (describe exactl 1141111110 Perc. Rate <br /> Privy home,garage, motel, e_ Dry Well czpft <br /> Well ,,,{ Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed W <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• s <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING K' N• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: G'��` Fig. A. 6. Location: O �- <br /> ft. x ft. — i q.ft. " ) <br /> 4 <br /> cn <br /> 1 N '3 <br /> 0 -T1 W <br /> .S_____.' L( !-- 4C k . .... <br /> ir <br /> ac <br /> t'l N' -. <br /> {ct <br /> \ O <br /> 7 <br /> V S <br /> �. <br /> Qw 'I 1 z <br /> • vie . <br /> Do <br /> CD <br /> i i..."... <br /> CO <br /> ,priv E <br /> CD 5.n <br /> 2. N a C. �rt n,� <br /> cn Z. c °; 0 'G <br /> O H < v: 2 <br /> 2 O O m m <br /> •O to s, E <br /> f �� (° <br /> ll / 444:/k f—/e—i y t\-, 0 <br /> > m <br /> '�ture of Owner or Agent Date ° C <br /> — <br /> X XI <br /> iemarks m m <br /> CD CD <br /> v <br /> .03 <br /> yN,! II <br /> nspection Date 977-e0 ,Q�/ .L•t-zia-i-c) \fto <br /> 0 0 0 0 0 b m <br /> Zoning Administrator'� o0000ocmn <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> fore 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 /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />