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e <br /> ,./ i i <br /> 3urnett€ounty Office of Zoning Administrator v o 0 <br /> 4'" APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use a) c <br /> ordinance, Sanitatio • <br /> n Code,and rviwith all other applicable County Ordinances and the l43_7 ssaws and regulations of the State of Wisconsin. g a >'' <br /> --,-)._--, 7,-,- 0 <br /> OWNER (please print) CONTRACTOR URVEYOR or AGENT Q �(\ 7 CD <br /> ADDRESS ADDRESS ,. `J Lv <br /> S .1 E._:e-.A.. LA it <br /> ADDRESS _,c ADDRESS � • <br /> 'HONE PHONE iss,; <br /> 'LUMBER WELL DRILLER <br /> O <br /> ,DDRESS ADDRESS m G) <br /> n 0�1 <br /> o' <br /> 'HONE PHONE <br /> z u, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms B <br /> o <br /> New Building Type of Construction: No. Bedrooms 0 <br /> Addition Y, Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type r <br /> 0 <br /> Grading Slope r-- 0 <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate pQ �.-'I • <br /> Privy home,garage, motel, etc.) Dry Well ` <br /> \ n <br /> Well Dec//[ Seepage Trench _ <br /> Subdivision Privy <br /> J Seepage Bed <br /> NicN <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road I � .� � <br /> ;etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o- <br /> � <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 1 - <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 7, <br /> )' <br /> 5. Lot Size: (��© Fig. A. 6. Location: fi, <br /> 3o ft. x . ft. — sq.ft. , , <br /> 0 <br /> to <br /> g <br /> CD <br /> (I 0 <br /> e_ PH A 5 <br /> 5' <br /> o <br /> 16. r = <br /> in O s <br /> Taw <br /> N o).-- <br /> c711- v5cncoz� <br /> CD C < m c m <br /> (o. Na _< - o <br /> 'a pi <. c ° E. 0 'D <br /> Z c Q ' : : a m <br /> 0 7 3. g <br /> al <br /> \, 6 70 <br /> � <br /> v „ m <br /> -6 •- , o <br /> Sign ure of Owner or Agent L Date �J X <br /> Remarks .. e _ / `; he /L'() e/656,v T 0/71a/4/ Via"-, J�� — m M <br /> file fia.� To h e ,gcL ,v cc /z e t CD <br /> d<to -' a//U k�-e I _ <br /> b y .Q0rr,i 7L /6 1 rr� ... /u s�t,tIt" G/c /066 a) II <br /> / �J /� \''''' <br /> _, �TI <br /> Inspection Date 4.2-,v.z.,,r .l y-Cf..�u�y c,;.) 0 0 0 0 o c`�i, m <br /> Zoning Administrator /f",/ o '0) 0 0 o cm/) <br /> IOTE: A preliminary site inspection must he 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 he 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 /> tg until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> rith 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 />