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V s77C:c!z >�1/•• <br /> Burnett County Office of Zoning Administrator c - -1r/ o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 o GJ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cow c C <br /> Ordinance, Sanitation Codei, and with all other.applica le County Ordinances and the laws and regulations of the State of Wisconsin. C "�` <br /> 7+ a 0‘ii) dit1-44%.... C V0eAkS 4/(Ek‘A.A-b6 1.S' - CU <br /> OWNER (please print) /_ CONTR CTOR r URVEYOR or A ENT jetr...... co CD <br /> li <br /> AD +-a pi m k cCi6S JC U 1..�' •m <br /> ADDR•p. � t f �o CD <br /> V \ +�� <br /> ACCESS \ ADDR Cair4l t ��TT �) ,� �` <br /> PH ( 0_) (.ig —2—- �2- (ails) PHONE 1U� A N cC (1 <br /> E O <br /> jRic-C 1..r7::: : (2_4 -1( _-4-2:7 ,,,\-\ PI <br /> FauiviU E H W <br /> 0 <br /> AeBR ES y`DB•R C CS <br /> o b <br /> PHOC PHt7Rt o r•• <br /> DESCRIPTION . y r <br /> 4. Sanitary Facilities: Li <br /> ° i- 0 <br /> 1. Work: ' / 2. New Building Details No. Bathrooms f o IANew Building . Type f Gonstru ion: No. Bedrooms o r, <br /> Addition ,'ol- :N,c}••, a- _ Septic Tank Size Gals. <br /> Sanitar Size . . ••• <br /> y ,.. ft. x . �T . ..... ft. J <br /> Filling Height... Stories 4a. Absorption Field Site: /A <br /> q +• Soil Type F m <br /> Moving Area �••��••••�tj•�•• • • <br /> Slope <br /> Grading 1i'— o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well k c; <br /> Well el Seepage Trench r,' <br /> Subdivision Privy <br /> Seepage Bed d--- <br /> N...J‘i <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road Sc' <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- (-A) <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ' C� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. h •,. <br /> 5. Lot Size pp.{.QS.�.^^ (� Fig. A. 6. Location: o • <br /> 1.00 ft. x . .. ft. — -1°,000 sq.ft. 1 —4:10 <br /> I. f1 m <br /> M . <br /> N 0 <br /> O "C ____J Pp °h <br /> N <br /> `✓plc P. LJ <br /> . . v tt ,-]01‘ - <br /> ---4") <br /> •- . J `i:,, 21 Laic, " ' ,-.1 n- <br /> T <br /> ) /' '45 , 1‘.---1: .' CD <br /> 100/ F--,. z- <br /> -.-- _ _ _ _ ____ f-'v.6qow Lle 'icy r- > <br /> CD <br /> s <br /> Zr7 , <br /> Us <br /> Git' t� t 70 co c v -. d CO <br /> W C CD <br /> CDNaas — n <br /> ,' o 5 m o • . 70 <br /> • . E <br /> •4..., ..k.:. viL„.4c.4 ..k.-0 b37:1 <br /> 42-7/: - <br /> Signature of Owner or Agent Dat <br /> � o aC <br /> X tDO <br /> Remarks T m <br /> CD <br /> 1A II <br /> �! (1..‘,,, {p <br /> Inspection Date 9hraa - Y,G '�Zt� 71.J .c0 <br /> 0 cs 0 o cn m <br /> Zoning Admi i15 strator a�`� 0 0 0 0 0 o w <br /> DOTE: A preliminary site inspection must be made and site apii oval granted on all structures involving sanitary facilities <br /> )efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing 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 /> vith 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 />