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e , <br /> .rrnfitt Comity • Office of Zoning Administrator ;v - 0 0 <br /> . ' ' APPLICATION FAR SANITARY — LAND USE — BUILDING PERMIT ' 3' 'N <br /> co -, o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H I , <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cv c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a <br /> O <br /> ../.6nrtfTy c.T. /71oCyut `e H <br /> cp <br /> OWNER (please Kfrint) CONTRACTOR or SURVEYOR or AGENT a CD <br /> a . . <br /> ADDRESS ADDRESS 1(' I V\ <br /> `.21. iq <br /> ADDRESS ADDRESS4i <br /> 6/2- V!Y- Q 9 N. <br /> PHO PHONE - N. Ni <br /> PER WELL DRILLER n� <br /> �xF _ <br /> ADDRESS ' <br /> ADDRESS m O <br /> rt 0 <br /> PHONE PHONE Z 3 (*� <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: ° o ° k <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••• ••• • <br /> New Buildingo. Bedrooms ° <br /> X.... Type of CoCo truction •••.•• a�1 z <br /> Addition F'f<#1✓1, Septic Tank Size Gals. O• ri <br /> Sanitary )C Size ..3.P ft. x 3 .. ft. 6,� <br /> Filling Height.../ Stories 4a. Absorption Field Site: <br /> Moving Area 0.0 rl F Soil Type r <br /> Grading Slope .,. ,- <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate O <br /> Privy home,garage, motel, etc.); Dry Well i. G^ <br /> Well /A.KE, C A i_ Seepage Trench V (" <br /> Subdivision Privy <br /> Seepage Bed t. `/ �., rr nn <br /> to (1) <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig. A. Include road •- e ?�, <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 , 1 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N `-° <br /> c <br /> 5. Lot Size: �/ Fig. A. 6. Location: t <br /> .�Q�, 07 ft. x 7 ft. - ..7/.5"V)- sq.ft. © i7'' TI <br /> ry <br /> NI ) ;\ <br /> to <br /> net N <br /> `•1 <br /> i iv <br /> 0o' <br /> 7' C <br /> 5 0 <br /> 3� ' �� �G <br /> fric„✓ , r <br /> ,( 1/3 ,4 3�1� ...L. Os z-' p <br /> m • °EA <br /> A- OWet( a) <br /> ait <br /> . Cr) 7 Vcoi <br /> m c m . m d c cc <br /> / mNaa � ' a <br /> II< .1 <br /> i o N y vc'�'* Im <br /> pD/h T L.�J, /00, 7 • . . : a' ;lam <br /> 151i�_ <br /> , -1 <br /> re.11€4. <br /> o <br /> i. � m <br /> Signature of Date ~'° C <br /> X a, <br /> Remarks -n m <br /> v <br /> CD <br /> II <br /> �11 <br /> Inspection Date � b b b b b b m <br /> Zoning Administrator o o 0 o o o fm/) <br /> IOTE: A preliminary site inspection must be made and site approval 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 /> 'Os 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 /> iith 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 />