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/ ,7 <br /> 3urnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> o �. <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD CD <br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. °.. i11 b <br /> .h. 0 <br /> (l..r'1.....�f... .............................. ... .����'.... .��,n sI................................................ <br /> 3WNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> �1 II <br /> a <br /> .7..Q7...... I.Q.n..f'C�....kl.X`..1..0 ....... r �'1... R.r...(........! —py.4-01�.................. . <br /> 4DDRE S.S ADDRESS ' '1 <br /> .a s ...... ct�n,. ...l��l�!..��.5..y.3..y............... ....... <br /> 4DDRESS ADDRESS <br /> `�7 <br /> :'HONE <br /> I.. .... ..5.. .....3.. . .. ........................................ .PHOY .3...: . ?..l..A........................................................ <br /> NE <br /> ..................................................... <br /> 'LUMBER WELL DRILLER <br /> S <br /> ................................................................... ......RESS.F"S. ..........................................................................., <br /> ADDRESS ADD o <br /> h < <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° G, <br /> No. Bathrooms 7 <br /> 1. Work: 2. New Building Details """"" o i <br /> New Building ... .... Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... ' <br /> ......... ................ ...................... . �i <br /> Sanitary .......... Size ....v2..�.... ft. x ...�..�.... ft. <br /> Filling .......... Height......q.. Stories .....(......... 4a. Absorption Field Site: <br /> Oc? Soil Type .................................... �: <br /> Moving .......... Area ...../........�........................... 4 ° <br /> Gradin Slope .......................................... <br /> g .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... T ry <br /> Privy .......... home,garage, motel, etc.) Dry Well , W <br /> Well p.... . Seepage Trench .......... R W <br /> ... . .Q.�R. .. 5.�.►^.�'E.l1..... Privy : <br /> Subdivision .......... .... !f`.�:.�1........................ ..... <br /> Seepage Bed .......... <br /> ------------------- ------- ------ ---------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <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. P o P <br /> ------------------------------------------- ------ --- <br /> 5. Lot Size: '? Fig. A. 6. Location: a► <br /> E..Q.Q.... ft. x . .SLR.!. ft. — ............................... sq.ft. ................. ............................................................. .� <br /> cn <br /> CD <br /> N o r <br /> (kl 11 We, 5. 3 <br /> �r,ie r L; ne o <br /> S K e- j 0 <br /> 1 S <br /> LL Z <br /> �0r'QL ° <br /> a <br /> CD <br /> 5 <br /> n v <br /> �o N r 7 N m Z <br /> m c v -. � v c CDIobt. N27 < <br /> ,P B v, < c ; M <br /> b Leh Z 03 ' : : M <br /> ° <br /> ,o <br /> ................................ . ..... ......$y.. - <br /> 'T p <br /> Signatur of Owner or Agent Date o b C <br /> X :2 <br /> Remarks ......................................................................................................................................................................... m <br /> CD <br /> +fl ' <br /> .. t <br /> ........................................................................................................... .. ................................................................... pp <br /> 00000 <br /> InspectionDate ....................................... ...F....-...... ................... ....... 66600 <br /> Zoning Administra or �J O O O O O <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 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 />