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�7p c.GH�2.6.Y. <br /> Burnett County, Office of Zoning Administratorv o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 <br /> a J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as — <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ; <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> .... .... ' .........�[�cav` ........................... ............................................................................................ _ <br /> a O <br /> d � <br /> {y/ m J <br /> OWfV/E�R�(please/p�rijn�t) q, q� CONTRACTOR or SURVEYOR or AGENT a <br /> .. .X5.1..../....{i!.T.!u.WR...� /. !'...�./... .............. . ............................................................................ <br /> . DDR <br /> ADDRESS ADDRESS � <br /> .?4. a .................................................... ............................................................................................ c, <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> n✓...... 1t.................................... ............................................................................................ <br /> PLUMBER , WELL DRILLER <br /> 7 ..3......'�?D�`..y70..... 4L ? ...... ...... ..................................................... g <br /> ADDRESS ADDRESS i m <br /> PHON .I1...-..... .:Ll..y. .. 1=i1oN0, <br /> <3. ..SP,i...................... E.......................... ....... ....................................... o <br /> Z <br /> DESCRIPTION 4. Sanitary r <br /> Facilities: I ° o ° <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details ......"" <br /> New Building Type of Construction: No. Bedrooms ....3.. � O <br /> Addition Septic Tank Size Gals. <br /> ...... <br /> Sanitary ,., Size ......4....... ft. x .............. ft. q` <br /> FillinglGradingg 4a. Absorption Field Site: ' <br /> .......... Height Stories ............... <br /> Moving .......... AreaSoil Type .....................-...:a "' o <br /> ........................................... <br /> Mobile Home ......... Slope ..................... .. .. ..f/Q.. . <br /> . <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ....................(Q ......... }r i <br /> Dry Well ^� <br /> Well ...,,,.... home,garage, motel, etc.) S'x <br /> Subdivision .......... Seepage Trench ........ <br /> Camping Unit ......4... .......................I............................ Privy ... <br /> Seepage Bed .......... . <br /> --------------------- Ill cn <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- C Q <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. fes. o <br /> ----------------------------------------------------------- -- r <br /> al <br /> 5. Lot Size: Fig. A. 6. Location: <br /> p v <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> t <br /> �CQS ��►;� },�QCs�� w <br /> N <br /> O L J <br /> J <br /> J <br /> V <br /> J <br /> 1 � <br /> o <br /> J <br /> Z <br /> Nit "= < <br /> d C <br /> i9 <br /> m <br /> Z eo' > n70 <br /> O <br /> Q.. .. /..�.`.P�:.. .`/ .... m <br /> Signature of Owner or Agent ff1� Da� QQ C <br /> Remarks ....4,/ a1c¢r......Jr.. .... v �/t ii✓...., 7-r,e�cY.....l5......Ndf 6N m x m <br /> ..... . .............. .......... ................... <br /> ........1°�Q. <br /> ......".1' .! ` .wh�......,.....,.1.1 o�--iv�s:/.�.: 7`.'� <br /> ...... ....../<.....................^.:�/. ....r0................. d' _ <br /> ........... ✓<.G1�.......... c�ac0.........(J4J�?e! ... c%c�.. . c�.f....c�c�s/y1e�P'vCase....tkoi �r it <br /> x .. <br /> C: ro -- m Nm <br /> Inspection Date ....................................... ..... ........ ......... ..... ........ ....................... 8 u, o u, o v, m <br /> Zoning Administr or �R' 0 8 8 8 8 8 Cn <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 riot purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may he revoked if misrepresentation of any of the information conveyed here- <br /> with 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 />