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Barnett County Office of Zoning Administrator v o 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 < — o <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Lend Use 1 c <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> K� <br /> op k S _ ° <br /> .!` n <br /> OWNER (please print) / F� CONTRACTOR or SURVEYOR or AGENT a � o <br /> R..k. ................. .:x.......... ....................... <br /> w\ <br /> ADDRESS ADDRESS <br /> P <br /> ADDRESS ADDRESS7� <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE iy" 'c\ <br /> til. .f .......... . . ....................................... _ <br /> ......................... ................................................................. <br /> PLUMBER W ..... WELL DRILLER <br /> K .. ? I <br /> ......... ..2.b ' . ..t...W...S_.......J�. `1 ...... T1 <br /> ADDRESS <br /> '{��� ADDRESS 'IBJ n 0 <br /> ..................................................... ............................................................................................ Z o .: <br /> PHONE PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o ' <br /> New Building T�y�ge�f�f nstr ion: No. Bedrooms ..... .J <br /> Addition .......... JCW.r.YL�...... �............... Septic Tank Size Gals. /.�.�.�I <br /> SanitarySize ft. X ft.Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site:Moving Soil Type .................................... r <br /> ....... Area ........................... ............... � <br /> Mobile Home Slope ...................... ° <br /> Fare. Rate ...... : Qr <br /> Privy 3. describe exact) , 1 -famii �'.. '3'""'.."' .Y <br /> Well .......... ome, garage, motel Dry Well .......... o .. <br /> Subdivision .......... .................................................... <br /> Seepage Trench ........_ <br /> Camping Unit .......... Privy .......... , '^ <br /> .................................................... <br /> Seepage Bed .. S <br /> --.__—_--__--_____________________________________ —_—_ IAJa1 N [� <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 FXISTING N < <br /> o <br /> STRUCTUH FS AND PROPOSED STRUCTURES AND ADDITIONS. <br /> n <br /> 5. Lot Size: Fig. A. 6. Location: C' b <br /> ......'......& ft' x�,.5.............. ft. — ............................... sq. ft. ............................................................................... <br /> 00 <br /> o � <br /> �T n' <br /> '1 :\v <br /> i <br /> a, <br /> V0 <br /> -bo <br /> 1�. as 'fin <br /> / z <br /> as <br /> a <br /> v <br /> JJ Vlr .Nm Z <br /> n O m c m <br /> n F <br /> v < <br /> m _. m <br /> Z 0 0' D n <br /> v — _ <br /> N\o : -I <br /> re <br /> ...9-moo-mss' _ <br /> Signature of net or Ag nt Date X <br /> .. _ r .. <br /> Remarks . .. ....:.. ...... ... ' .. :° y�r........................................................................................... Q <br /> m <br /> ........................................................................................................................................................................................ — <br /> II <br /> ..................................................................................................... ........................................... int <br /> ... . .................. ........ <br /> Inspection Date // 'l--' S �i N �' N m <br /> p ..�G.i:-.�....... ............. a4.'7:4�'.4..,...:..... ................. ....?:!�.......................... `�: yn rn ogn o �n m <br /> Zoning Ad Inistrator !<"J $ $ '$ $ N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facll iti 's <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 rnade Without approval of the Zoning Adminlstratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />