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Burnett Courrty Office of Zoning Administratord 0 0 <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 H •1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requiremen of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Or nances a the laws and a latici of the State of Wisconsin. 3 a <br /> Wally Brown and Sharon„Burke ... . • • •.. ... .. ......... ...... ... <br /> OWNER (please print) C RACT R or URV OR or GENT <br /> 1771 Selby Avenue G ? <br /> .. ........... C!lG.(2...................................... a t <br /> ADDRESSA D SS •� rn. <br /> 55104 <br /> a....... ................................................. .. ...... — <br /> ................... <br /> ADDRESS ADDR S i( <br /> .. ��. .Y..y3..3 <br /> PHONE PHONE <br /> 612-645-0572 ...... . .. . ....................................................................... <br /> ... ............................................................. <br /> PLUMBER WELL DRILLER �•''•� <br /> i <br /> Central„Plum bing................................................. . . ...... . ............................................................................... t\ o r. <br /> ADDRESS ADDRESS <br /> Webster WI <br /> .. .............. . a.................................................................... . . . . .................................. . ... .... <br /> ................................ ^ <br /> 054893 . .. <br /> PHONE 866-8 ....... <br /> Z H <br /> DESCRIPTION _ <br /> 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms .. .... ? 'i <br /> New Building Type of Construction: No. Bedrooms ....�.... <br /> 9�f ........w...ifiL. . C.0 .T... (.P..00. <br /> Addition „ ,,, - Septic Tank Size Gals. n . <br /> Sanitary Size ...2.%4-.7.. ft. x �'" ft. ••.• ?t t i ji�' <br /> Filling/GradingHei ht............. Stories .. ............ 4a. Absorption Field Site: <br /> .......... 9 <br /> Moving .......... Area ..,.,.,.•... Soil Type ...... .......... <br /> . <br /> .. .... ...... <br /> Mobile Home . . Slope .......... ..... .�. ... �: <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ........ .-.... ... ............ <br /> weuj(.,,, home,garage, motel, etc.) Dry Well ;q <br /> Subdivision ,,.,,,,,,, Seepage Trench .......... ;) <br /> ...ane...faml.l.y...home............. Priv <br /> Camping unit .......... and...garage......................... y ....�..^ t <br /> Seepage Bed ....P... :T <br /> ------------------------------------------------------------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 'C i f <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Ad <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING u < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C, :T o, <br /> -- <br /> - <br /> ——————————————————————————————————————————————————————————————————— -0 <br /> 5. Lot Size: q,I Fig. A. 6. Loc tion: <br /> ,191 (1 ft. x ... <br /> /..�. .. I2,/r760U jn - o <br /> l0 ft. — sq.ft. Vf,L..l..r .Z'.l!.fr..t7.rt..�:�1.)..�a....................... <br /> /i Z <br /> f a <br /> �ifS•--� j.S F <br /> o .� <br /> w 3 <br /> z <br /> � d9 � dimZ <br /> 0 tnan < A '- E <br /> m <br /> Z C, aam <br /> O <br /> A <br /> p/ a <br /> .. ...... ` .a. y..�.......... �0.. .��-4 Date fo.............. C <br /> SAg nt =� ° <br /> ig a r of wine or <br /> X70 <br /> RC`narks . 1. .(r.. !`.,��,�f..`•.:.................................................................................................................... m <br /> v <br /> ........................................................................................................................................................................................ � — <br /> � II . . . . . <br /> T <br /> Inspection Date ... J- !/���s���• ���`� t,�' G' o E 85 <br /> Zonin dministrator 4 $ $ $ <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 />