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Burnett County Office of Zoning Administrator fC <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the ,$ q r� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3d <br /> regulations of the State of Wisconsin. » ' <br /> AR E . f y� $ CONS7RVCTiav <br /> OWNER (.K.............K.R..A.u..S.�........................................... >" <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or <br /> G.I.-J. <br /> . .................................................................................. ....... a .� <br /> ADDRESS ADDRESS ,°1. W <br /> ... WEes.VR...Wks..•..-54 893 a <br /> .............I..................... .... .................................................................................... ....... <br /> ADDRESS ADDRESS '� ° '• <br /> 866-8�e8 6-.V.95............. .................................................................................... ....... 7c <br /> PHONE PHONE ; <br /> ........................................................................................... . . ..L...D.....RILLER................................................................... ....... <br /> PLUMBER WEL <br /> ........................................................................................... . . - <br /> ADDRESS . ....................................................... ....... � <br /> ADD......R.ESS.. ............... 0' c <br /> ........................................................................................... .....PHONE............................................................................... ....... - N <br /> PHONE N <br /> DESCRIPTION4. Sanitary Facilities: ° o 0 f� <br /> 1. Work: No. Bathrooms 1l <br /> 2. New Building Details •• ••••••• : <br /> o <br /> New Building ...... Ty a of Construction: No. Bedrooms .. ....... i R <br /> -� <br /> OD • FI2 Septic Tank Size Gals. .. ....... <br /> Addition Occ .... .. ........P.........AA%................... .. <br /> Sanitary .......... Size ....10...... ft. x ...2g ft. .. ....... <br /> PIIIinpl Grading ...•••••.. Height............. Stories ............... 4a. Absorption Field Site: ?� <br /> Moving .......... Area Soil Type ............................ <br /> ........................................... ...... o <br /> Mobile Home .......... Slope .......................................... .. <br /> v Z <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................ ...... <br /> Well .......... home,garage,motel, etc.) Dry Well ... ...... m <br /> Subdivision ,,,,..,,,, Seepage Trench ... ...... o <br /> i <br /> __Camping Unit___________________ Privy- .... _I . <br /> Seepage Bed ......... S a <br /> N <br /> _ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is in in Fi Fi .d A.. '� C <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ------------------------------------------------------------- <br /> 5. <br /> _______________________________________________________5. Lot Size: Fig. A. 6. Location: <br /> .� <br /> ................ ft. x .............. ft. - ............................... sq.ft. �j a <br /> J o � <br /> 0 <br /> o <br /> ee CA ) I <br /> M 0 <br /> 2 <br /> O <br /> N <br /> A.Zt <br /> �><r 5�� Mot..be S�6<wrL • � � � d d � � m <br /> MD Ap < J J n m <br /> � �a� — � �asss <br /> d y J J 3 <br /> z fO (0 <br /> 0 fR Q `G D <br /> 0 n . <br /> 0 2 m <br /> 2 ° O <br /> ° .. .. ' ................................. .31Z4./..88.......... <br /> M <br /> Signature of Owner or Agent Date 'o O <br /> o : <br /> Remarks <br /> A •• <br /> q. W <br /> OO . <br /> .......... .............................. .. <br /> Inspection Date ....................................... ....'`. �... ....... c.-� ..................... . N o o m <br /> Zoning Ad inistrat $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faci ities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to thisapplication before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been ssued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or sl iecif!cations shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />