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s 4 <br /> 3urnett County Office of Zoning Administrator c o Z <br /> • <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT B = — <br /> .D '* o <br /> fO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H O <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use s O <br /> ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ,C o- O <br /> OWNER (please rant) CONTRACTOR or SURVEYOR or AGENT <br /> oyLi <br /> �� 1 a I\ <br /> 4DDRESS ADDRESSCD <br /> S t if e/K./ I. 5 C- <br /> 4DDRESS ADDRESS N" <br /> Nzi <br /> 'HONE PHONE %‘"1 <br /> PLUMBER <br /> WELL DRILLER <br /> O <br /> ADDRESS ADDRESS co o <br /> r+ < <br /> o' ,4 <br /> PHONE PHONE z H ' <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 13 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details � <br /> New Building Type of Construcion: No. Bedrooms co <br /> Addition wI� Septic Tank Size Gals. <br /> Sanitary Size Fa ft. x a 41 ft. N6)clth%YN"+K 9.00 0 <br /> Filling Height Stories . ..j 4a. Absorption Field Site: <br /> Moving Area c?1 O 1t Soil Type J� o <br /> Grading ( a.ISo 81t10 �k) Slope 1116 0 <br /> Perc. Rate 1 <br /> Mobile Home 3. Use (describe exactly, 1 -family .-0 N Privy home,garage, motel,etc.) Dry Well _ >- 01) <br /> I,Well / F4f,w�. Seepage Trench LP <br /> Privy Ul <br /> Subdivision VJN C. ti I — <br /> Seepage Bed — <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road <br /> acil <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 !' L Z. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o a <br /> ( N... <br /> 5. LotSize: �� Fig. A. 6. Location: \ <br /> ft. x ft. — sq. ft. ( <br /> Nj t F <br /> N O' <br /> 3O IZ 7 <br /> 1d � pro,OS� 2 T 7, vj <br /> �-44 ►,! E70A, o N —C <br /> 14') x.=> -4 t —1 <br /> 30( <br /> rt-7— i) — Also la 6 e___ . <br /> 3 <br /> z /A 131,,e-1101 X) 1-- i w <br /> am O <br /> s <br /> m <br /> co <br /> -4' \ti..in <br /> C <br /> t . ,3 �r- -13*(nCOz <br /> CD � D, ' <br /> CD. N-°-< 74 a� <br /> -a cn < C �' S'0 'G <br /> ffr OH H � �n m <br /> z oo fD . : 2. <br /> o a <br /> MI <br /> v� S _ <br /> cal <br /> `II —I <br /> � o �p <br /> 73 m <br /> Se-- <br /> CD Cs <br /> {3 0 C <br /> Signature of nOwner or Agent^ `/ / Date / J .- <br /> Remar s .../U.64.J 5��� el e 67'�Fl44, ,r o - 02$— 83 t.G11Xlek— m x <br /> / TF / / gf,/ CDfrk <br /> �X r41 ,` � <br /> •S --+ UI N <br /> T <br /> Inspection Date 0 o 0 0 0 o v, rr <br /> `Zoning Administrator o00000v <br /> NOTE: A preliminary site inspection must be 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 />