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Burnett County Office of Zoning Administrator V c c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v 3 0 <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 al I work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Coda,and with all other applicable County m CountyOrdinances antl the laws and regulations of the Stet.of Wi Cod,n. 3 R <br /> 4.tVa. .....J,... Et.a.m..pSo.n�......_ <br /> ................................................. ......._.................. - g <br /> OW(yy—F R'l p/lease tl/'` / 1` Q / CONTRACTOR or SURVEYOR or AGENT ^ °CZ ` rt <br /> ADO.ESY,..�n..,IM....._G�IrV. T../...FJ................ .ADORESS..................................,................................. <br /> ........ <br /> _ C <br /> Sh..a..re>t.r...e.,?........M....ru..... . ... .AooiESS........................................................................... <br /> ADDRE�FS <br /> (61.9).......... .. ...4�..-..�.`�—..3.2........... ........................_.................................._......................,....... <br /> P PHONE : 'A <br /> oder...r:<k....../l o.p..K,:.Ns............... ..........................................................................I............. <br /> LUMBER WELL DRILLER <br /> U 1..e.ks...t.e.r...t.....t ..L........5 .f(9;...... <br /> . .....,..... _. <br /> ............_......... ....... .................................................ADDRESSADDRESS ., <br /> G` R............ F ..-.... 5..7............................. ....................................... ..........................PHONE PHONE <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° B <br /> 1. Work: 2. New Building Details No.Bathroomk ....�,... i� <br /> New Building No.Bedrooms <br /> ..7..(.... Type of Construction: .... <br /> Aaamgn Septic Tank Size Gals. ,2SO "� 'e <br /> .......... ...................................�.../� ..... T <br /> Sanitary ..X... Size..o�.+.1TCC. ft.x .aZ..T.... ft. ���••�Q� —��l � `I <br /> FIIIIngorading Height 4.s�..,.Stories...e�w...... 4a. Absorption Field Site: n <br /> Moving .......... Area .SSG. '.. Soil Type.................................... <br /> .G� .................. <br /> Mobile Home O Slope <br /> wwv .......... 3. Use (describe exactly,1 family Parc. Rate........ ..... v <br /> Well .......... home garage,motel,etc.) Dry Well ......... �4 <br /> Seepage a e Trench <br /> Camping Unit ........., Privy .......... i i <br /> .................................................... <br /> Seepage Bed t i(y <br /> Location of proposed structures and existing structures,wall,sewage systems,mal etc.,should be sketched! in Fig A. Include mad n g !p <br /> setback,side and back yard dimension and location and setback from all bodies of water.if property is located m e highway inter <br /> :Cellon,show the Intersecting highways and the setbacks required along them and at the inersh,lon.CLEARLY LABEL EXISTING ^.s -' �. <br /> X <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. w - <br /> tl F <br /> ---------------------------------------------------------------------- <br /> m <br /> 33$$��y� Fig. A. 6. Location: to <br /> 5. Llf.Y.4 <br /> sq.ft. .SL'll...P14f..,IllT.NIN_411 JQNG G� = <br /> I <br /> i <br /> 91% <br /> t� <br /> N v <br /> S 12 <br /> VI p Wr p� '7 o <br /> sl' D <br /> 9 4 <br /> ® l obCo.S� d ? �•t�� ango3 <br /> PT On Z C <br /> Z in <br /> <d g <br /> O P - <br /> o _o nom <br /> �a$eptie�. .2nad � <br /> ....... `c« m <br /> Mill. . .. . .. ................. .... . .. ...... .... iso C <br /> ignature of O r Agent Date :',. <br /> Remarks ...................... X : 71 <br /> ..................._................................................................................................................................................. <br /> ................. : t <br /> n <br /> Inspection Date ....................................... ....'17.+... '.. ............... 1� m <br /> Zoning traamo <br /> NOTE: A preliminary site inspection must be made and Site approval granted on all structures involving sanitary facditius <br /> before construction Can begin. In the case of sewerage disposal systems,a copy of the percolation lest most 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 bond <br /> Ing until a permit has been issued. A Permit may be revoked if misrepresentation of any of the Information conveyed ll <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Admimsbetor. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />