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Burnett County Office of Zoning Administratord 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3_ <br /> G 0 L <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as j <br /> shown Ordinance,reihailundersigned that all work shall be done in accordance eor <br /> with the require of the Burnett County Land Use e <br /> g <br /> an with all of era applicable County ces and the la and egul tions�oll.�.e St tWlsconsln. 3 ma <br /> 9\�–]�E��e/��/\ /�l P m�5`\/ <br /> s ... ..V• eta.. ..C.NJf.. .. ... .. .f./.1.,..�.1 .. ... r............... .... <br /> a 0 <br /> 06i>lease p>r- TRACTOR or SURVEYOR or ENT ` a <br /> ...4.. 3Q.. � is <br /> . �.�. <br /> . ...........c.,nv .....�1� ..... ............. Ro.C�O.....` .G v�2�J'....W.! <br /> // <br /> A RSS ADDRESS � I j <br /> ................................................................. <br /> ADDRESS ADDRESS <br /> PH IS.-...` .3.K.-...0. 3.x.................. .PHONE. '..5'...:.'zo.S ..................................... h <br /> C LS <br /> .............. <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .A..D...DR.....ES... .......................................................................... ... O v <br /> ADDRESS S <br /> o <br /> o' <br /> ........................................................................................... ............................................................................................ ,» <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sa 'tory Facilities: <br /> 1. Work: 2. New Building Details No. athrooms .. o <br /> New Building .......... �yf7.;j Constructio SepNo. B rooms .. ...... � <br /> Addition „�„�,,,�p.-yy,� a; yr!� Septic nk Size Gals. .......... <br /> Sanitary ... Size ....,lA..... ft. x <br /> '� 1 4a. Absorption ield Sit <br /> Filling .......... Height../.y;�..,., Stories ......, <br /> 9 j i(/... Soil Type .... ..................... u <br /> Moving .......... Area .... ... ............................ <br /> .... . <br /> Grading .......... Slope ............. . ......................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .... .. ................ <br /> Priv ......... <br /> Y .9ar 9 e Dry Well .......... -- <br /> .......... ho <br /> Well Seepage ench .......... <br /> Subdivision ` -t� Privy ............. <br /> Seep a Bed .... ... <br /> - <br /> ——————————— ----- ------------------------ --- - <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig A. Include road e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- [� as. <br /> cc <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING f� o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----------------------------------- ------------- — -------- -- J. <br /> 5. Lpt.S (� ,y� Fig.—A. ocati l T <br /> !!u1.. .. ft. x�R }.. ft — ...{.���lN. sq. ft. �YC�.•.>�rS ...... .. i (� <br /> N <br /> 0 <br /> J'' b z <br /> I+ d <br /> Up-f- bP <br /> �C <br /> $, Naa< — <br /> d <br /> a cn c, a < . * m <br /> Z o o' m <br /> i� o <br /> gn <br /> cn ..\J. ......... .. .-5..-.fid.. �'- p <br /> 0 <br /> Q � <br /> re or Agent Date <br /> x <br /> Rem s ... '. ..K.0!4 ...4?,' � , .\..... ............ .. `-� :.......C.1.�. ...—...'C:. ... .......... .... T� L 0 <br /> (\ .... .. <br /> .....�. .. �.. .. w'•� ...... m i .L'r <br /> .. . <br /> .......................................................................................................... ... ................ ................................................... <br /> r r r n N T <br /> v, m <br /> InspectionDate ....................................... .... ..... .... ..... . ....9... ............ . . o 0 0 0 o m <br /> onin dministrat . o 0 0 0 o N <br /> NOTE: A preliminary site inspection must be made a site approval granted on all structures involving ssanitary facilit iL” <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 penult may be revoked If misrepresentation of any of the information conveyed here <br /> with is found to exist. Changes 'm plans or specifications shall not be made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT RE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />