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Burnett County ' <br /> Office of Zoning Administrator W - Z� <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � 3 � �, <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 all work shall be done in accordance with the requirements of the Burnett County Land Use o <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. I y h W <br /> a <br /> ......................................... <br /> �R rues ri c e Leo p /eS ��ncre7� /�lQso �- h <br /> OWNER (Please print) /. y m O <br /> CONTRACTOR or S RVEYOR or AGENT ' ' <br /> l3o Sv.�s�t Hebb �R 4u/ sCD <br /> 91� _ :h <br /> ADD R S ... ..................................................................... <br /> ADDRESS <br /> �P.� s-�oaa <br /> ..... � , �..... <br /> �s .... <br /> _ 9 <br /> R ADDESS .AD E E... SS <br /> ..... .............................................................................../�/S <br /> ................�....................................................................... <br /> PHONE ....................................... <br /> PHONE <br /> ............................................................................ <br /> r715J �,S 9 -93S- <br /> PLUMBER . ......................................................`� <br /> WELL DRILLER pa <br /> ADDRES <br /> ADDRESS S. ............................................................................ o <br /> —• <br /> 0 <br /> ................................ . . ...................................................... <br /> PHONE . ........................................ .. .. .. <br /> PHONE . <br /> DESCRIPTION z4. Sanitary Facilities: r '� <br /> 1. Work: ° o ° <br /> 2. New Building Details No. Bathrooms -o <br /> .. <br /> New Building 3... L <br /> .......... Typ of Construeyy'on: No. Bedrooms <br /> Addition down ){....... Pirr.?h y .U/�r,{� Septic Tank Size Gals. C <br /> Sanitary Casement) .......... Size .....�i ft x .... a.. ft. <br /> Filling / ...�� .......... r <br /> .......... Height 7...�....... Stories ....1........ 4a. Absorption FielcjSite: <br /> Moving Area �o?�1 Ford <br /> .......... .......... ................................ Soil Type .................................... i <br /> r Grading Sloe .......................................... «: o <br /> .......... . <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ............. r« <br /> ...................... <br /> Privy <br /> .......... home,garage, motel, etc.) Dry Well <br /> Well <br /> Subdivision '••�• ?••` fI0/7!C Seepage Trench <br /> .......... Privy <br /> Basic .................................................... .......... <br /> ---_ Im en � Seepage Bed------------------------------------ ________ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road n <br /> ;etback, 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 t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _� <br /> ------------------------------------------------- Y <br /> y <br /> --------------------- O' <br /> i. Lot Size: 4�/0/?aY, Fig. A. 6. Locati n: <br /> ... $6..... ft. x .... 5a 9 <br /> ft. — ............................... sq.ft. „LOT ..... �/.. r S� <br /> Coo/n <br /> CD <br /> 0 <br /> t O 7 <br /> ' f80/ <br /> v � <br /> CD <br /> CD <br /> o�N �o � 0 � z j <br /> � CD <br /> LD <br /> NQQ� _ ' Q � <br /> Z O O• `D <br /> o — <br /> o —I <br /> c(�o <br /> m <br /> .......... <br /> ature of Owner Date <br /> 'marks .........................'.y! <br /> ; <br /> ...' ...7... / ............................' ................ D <br /> ...................... o <br /> ........................................................................................................ ' <br /> . .. . ................... <br /> ;pection Date ....................................... GZ�'??QQ� —.� f.... � o 0 0 0 0 �' m <br /> .......... . . <br /> Zonin 9 Ad istratorr� : : o 0 0 0 6 o CA <br /> TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> > application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> h is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />