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rPy Office of Zoning Administrator i' -o o 0 <br /> LICATION — — <br /> fADMINIST RATOR: The undersigned hereby makes application for a Permit for the work desribed and located as — <br /> undeFOR SANITARY LAND USE BUILDING PERMIT <br /> rsumad agrees that all work shall be done in accordance with the repeirements of the Burnett County Land Use o <br /> Ordinance, Sanitation Code,and with all other mid.r.ble County Ordinances and the laws and mi,olatlans of tha Slate of Wlecons- 3Q -p <br /> a <br /> J. .. ........... ._ ...ys......_r............._..............._:.: ..._...._............................_..............................._....._........._ <br /> OWNERIPIesse print) q CONTRACTOR or SURVEYOR or AGENTas <br /> a T <br /> A�1.PA.........NL.Y..h..S��r.....(.7.� _ _ <br /> ........................ ._....... ...................................................... 'a S <br /> SS ADDRESS m Q <br /> .... .........P7.. .. ........;a .r ............ F.SL.L.b..... . ............................_............................................................ Ida <br /> ADDRESS ADDRESS <br /> ......,............/y................................................................. . ................................................................................ <br /> PHONEPHONEA <br /> ALL, <br /> O�. .. ................................................. ........._...................... ....................................... <br /> PLUMBER WELL DRILLER <br /> .o ro <br /> ADDRESS ADDRESS 0 , <br /> 0 <br /> ........................................................................................... <br /> ............:............................................................................... <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: I ° S ° <br /> 1. Work: p, New Building Details No. Bathrooms "� """ 'a <br /> � <br /> New Building .......... Type of Construct' No. Bedrooms ..a-... Vt t)\ <br /> Addition ...... wr.Q..`�..(...5 ..Gri.0 Septic Tank Size Gals. <br /> _.. ......... .. •7S.U � O <br /> Sani[arV ...x... Size .............. ft. x _.........__ f[. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: $: <br /> Moving .......... Area Soil Type :............__................. o <br /> GradingSlope ....................................... <br /> Mobile Home .......... 3. Use (describe exact) 1 -family Pere. Rare ................................ <br /> Privy .. home,garage, motel, etc.) Dry Well .......... _T <br /> Well .... Seepage Trench ....... .. <br /> Subdivision Privy .a...... <br /> .................... ............................... . <br /> .......... ................................. .................. <br /> Seepage Bed fird,X�'.>.y V^ <br /> Location of proposed structures and existing structures well,sewage systems. roads etc.,should be sketched in FiA A Include roatl �� .be V i, I <br /> be <br /> satbai side and back yard dimension and location and setback from all bodies of water. It Property is located at a highway inter- <br /> twice, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING s <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADOITIONS. <br /> --------------------------------------------------------———— <br /> 5. Lot Size: Fig. A. 6. Location: <br /> �0 <br /> �N Z o I <br /> o J <br /> O <br /> 0 <br /> rti v <br /> m :O <br /> z a I <br /> 0 <br /> f <br /> S <br /> m O+ry mZ <br /> Nl f <br /> Rif <br /> - z ooan <br /> '�° A pl <br /> ° S3 <br /> ya � Sy A_ <br /> � _ A ml <br /> NZ <br /> .........:...................... ....... ................. ........... o OnD,to <br /> Remark�_ ,u{{.. '6 0302................................_................................_................................................ m X i m' <br /> .....P... .C.l..L r-//Q iC/-a'fL..��.._........................_._9" <br /> / �T[v. Cubing 'minlstrato '..................... 000 ooM <br /> .... `,Y/.. `O�! an <br /> Inspection Date ' t <br /> NOTE: A prelinlinary site inspection must be mode and site apprnytd granted on all SULndl resInvolving sanitory la"Huns <br /> before construction can begin_ In the case of sewerage disposal systems, a COPY Of the percolation test must In,, 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 /> - <br /> ng until a penult has bean Issued. A Permit may be revoked if misrepresentation of any of the information conveyed halo- <br /> with is found to exist. Changes in plans or specifications shall not bt, matte without apprOvol of the Zoning Administratpl. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />