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car ' <br /> ett County Office of Zoning Administ ator Or o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 = i, <br /> — o cS <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and lac < m <br /> ted as � , <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County La d Use ` <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsin. 3 a i0 <br /> o <br /> l.C..n..rS. .a........ .... <.r . ....................... .......... ......... <br /> q` ...... . . . . . *yy� <br /> OWNER (please int) CONTRACTOR or SURVEYOR or AGENT a m <br /> N...q..l...... ..... . ..r..q.K..�.. ........ ..v........... .................................................................................. ......... a <br /> ADWADDRESS <br /> ...... .'...Aqu.. .:.. .h .......s.. ....!......6............. ................ ........ <br /> .................................................................. . <br /> ADDRESS <br /> ADDRESS ........ .U7 ico <br /> ..r.. �.y.-..3.�� .............................. ..... . . . <br /> PHONE PHONE "T <br /> i............................................................................ [ <br /> PLUMBER WELL DRILLER J <br /> O ` <br /> ADDRESS ADDRESSn 0 :T <br /> o <br /> ....... ......... <br /> ........................................................................................... ........................................................................... o <br /> PHONE PHONE <br /> u, <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0- <br /> 1. <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ��•������ :� o i <br /> New BuildingT - No. Bedrooms <br /> ype of Construct) ••• •• •• m [� <br /> Addition ...,,..... ,• Septic Tank Size Gals. ......... <br /> ................. ............... .... <br /> Sanitary ... Size .............. ft. x .............. ft. ......... :W <br /> Filling/Grading4a. Absorption Field Site: <br /> .......... Height............. Stories ............... r <br /> Soil Type .......... ... <br /> Moving .......... Area ........................................... YP �6,.�. . ......... -A o <br /> Mobile Home .......... Slope ............... ............. .. .�... -'�!i -^ <br /> Privy .......... 3. Use (describe exact) 1 -fa <br /> Perc. Rate ............ ..... . <br /> Well .......... home,garage, motel, et . Dry Well .......... <br /> Subdivision •.•••..... Seepage Trench .......... py i <br /> Camping Unit .......... ..... .............................................. Privy ...... <br /> -, <br /> Seepage Bed .......... <br /> ------------------------------- ---- --- - <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketchA <br /> ed in Fla. . Inclu e road iv <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter r acsC <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EX 3TING <br /> r, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p -;i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 1 1 <br /> ................ ft. x .............. ft. - sq. ft. <br /> ben <br /> O J <br /> J <br /> to �: <br /> r. H <br /> 1 s <br /> / N 1 <br /> 0 C <br /> O <br /> ( at <br /> ti' J <br /> m <br /> 11/ <br /> Dw <br /> Pat <br /> � C N <br /> n yj CO' n <br /> 6N. em <br /> Z Ino' a57J <br /> O J n n <br /> �o m <br /> .. ..... . .. .... ........................................... ...................................... (n o C <br /> Si nture of er or Agent Date ' I — <br /> X S <br /> Remarks ................................................................................................................................................................. ....... ,-I : m <br /> O <br /> er, <br /> ................................................................................................................................................................................ ....... — <br /> it <br /> .............................................................................................................................. .................................... . '� <br /> Inspection Date 1 �. N N �.�^ m <br /> ....................................... ... .... . . . ..........9. .. ... . . .. ....... <br /> Zonin Adminis attY or- 8 8 8 cn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures I ivolving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatico test must be attached to <br /> this application before a permit will be issued. Do riot purchase or install a septic tank, do any pit robing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the in Intonation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />