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c ---$.--7 .J�- <br /> Bu'rnett County •$ • Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT " • <br /> . * N <br /> TO TI4F!<ZONING ADMINISTRATOR: The undersigned.hereby Makes application for a Permit for the work described and located as v, °' ?AI <br /> shown 5erein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cc c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a N <br /> CY-4 e/es SAii 33 e l = a .. CC r:.y ,- G <br /> 2i <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT q a m <br /> ?(-3 •t aws✓ v t r4✓E <br /> ct, <br /> r <br /> ADDRESS ADDRESS <br /> 6 ,,,, <br /> .ARESS ADDRESS A � <br /> 'o ,!. 7..ri ` q7 ,.. <br /> `PHONE PHONE �' f,A <br /> Al.-e.(S /(' eP-p-e/- -1 s., 0 <br /> LUMBER WELL DRILLER ru r- 04/ <br /> IW.t S'l-el— ( "-CC w M o <br /> ADDRESS �jP6 or ADDRESS (n /�( /) <br /> O _, C` <br /> DESCRIPTION ^ <br /> PH E PHONE • <br /> z y r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ( �;� • v <br /> New Building ir Type �tructi No. Bedrooms ..r 8 <br /> Septic Tank Size Gals. <br /> Addition r`"� p .v, ,< <br /> .�,� pp-- . ) <br /> Sanitary Size ... P.. ft. x .3. ft. <.. <br /> Filling Height Stories .'t 4a. Absorption Field Site: �A/ <br /> Moving Area Soil Type q, (h r <br /> Grading Slope / . .O ° <br /> Mobile Home 3. Use (describe exactly tillM Perc. Rate 3^3" <br /> 3 <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed ./.-`..... <br /> N <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- n _a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING C <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> Ff...oR <br /> ft. x ft. — sq.ft. <br /> cn <br /> CD <br /> tviat* I00* 0 <br /> g. <br /> vJ <br /> o ti*i <br /> rF <br /> T <br /> o <br /> ��` z 1 <br /> f° <br /> -V <br /> Gf <br /> li <br /> Xl Nr13* v)Wz <br /> m c CD �. cp m c m <br /> -5 cri 74' .,a' 5'� 'O <br /> .* o• N N < <n m <br /> z o 6' f' . : E. 70 <br /> 0 3 <br /> /Lef 4-et)r oo <br /> F--/` ? <br /> m <br /> O N 0 <br /> Signature of Owner or Agent Date ° — <br /> DO <br /> Remarks ..0.1 - " u�.�� ` x m <br /> m <br /> CD <br /> 7 u <br /> 9 <br /> Inspection Date •-5 7-- /flJ .�/ 0 0 il <br /> Zoning Admi 4 ° iE o 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitie <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 permit may be 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 />