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Burnett County Office of Zoning Administrator c 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 n <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and loc ted as '� H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County La d UseOrdim c <br /> OWNER (plea4— <br /> se Code, a\ with �h IISE County Ordinances and the laws and regulations of the State of W's onsln_ 3 a i <br /> Hance, San I,/' pp y g i <br /> ... .. ... . . . ........................ .... ... .... . .... ............... ...... <br /> E do <br /> Ip pn t) CONTRACTOR or SURVEYOR or AGENT a J <br /> a <br /> �. — � <br /> ...........141-`1............................................ <br /> ADDRESS r, ADDRESS <br /> f/ sri�v�s M ;,,IN <br /> ADDRESS . . .. ..... ..................................................... ADDRESS <br /> . .-. ..3. -...s:. .49...................... ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ............................................................................................ -. <br /> ADDRESS ADDRESS m � <br /> n o <br /> K <br /> PHONE PHONE n Z H � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••••'••••' o <br /> New Building Type of Construction: 00C t< % " No. Bedrooms .......... t, <br /> Addition ...,....,. Eiq rE k1 loo D Septic Tank Size Gals. <br /> ?./l.. !?........ <br /> Sanitary .......... Size ..../..f7..... ft. x .... .g.... ft. .......... . <br /> EiltingiGred ing .......... Height............. Stories ............... 4a. Absorption Field Site: ! i <br /> tl <br /> Moving .......... Area Soil Type ......................... .......... o <br /> ........................................... Slope ............................... <br /> Mobile Home ,,,,,,,,,, 1 <br /> Priv Perc. Rate ........................ . <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Well ........ home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... 61...W ,( l.(5/ Seepage Trench ....... <br /> Camping Unit - Privy .......... <br /> d s.�k.....................I................ <br /> (7 tllnl F e K <br /> A Seepage Bed .. ....... O . <br /> -- ----------------- ------------------------------------ --- .an <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched In Fig, A_ Inclu e road <br /> c <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a hlghw y inter- °- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Lo ation: owC LaK6 : <br /> ,,// a7..G.y� sq. ft. L.Gy..�. ..,� G6 7-1F/V R.E,]..r✓. ..... .rtle � Cly.: <br /> .�1 ...`J... ft. x . IJ�..T.... ft. — . ...�, <br /> �� �T /off (Ui�h 5eck avef�9ln-� r �I e � an <br /> J n <br /> TZ60 <br /> N <br /> o <br /> L Af L- ezda� <br /> cab, 7U <br /> T <br /> Task <br /> +' 2m, - z Z <br /> 0 <br /> Zcll <br /> d <br /> -,rL n I` �rJ'cas-.rel (n r a w <br /> p ra i 4 r f) c m <br /> r z� �r✓L'd�rr-dC �N.t-(¢dam�, : <br /> '^o' n ro <br /> m <br /> 0 0 0 a 70 <br /> .............��-P...... ............ ... ...... ...... ... . ��BP o p <br /> i ature of wner or Agent - ate l C <br /> IJ. <br /> 1711 <br /> .. ....... .......... <br /> a. . ...... .. �. ...�..�.../j.y.�..�.'.�."�.�.�.f./j.am../�../J..... .y.t�........ <br /> . �'h. -- ..�. . .. oD .. <br /> .... <br /> . �x <br /> . .,. .......... ........... <br /> ...� .......... <br /> .... <br /> ....... . . . . .................. 5 .. . .. ....a .... <br /> ..... .J..v�::: : :::: II <br /> m. <br /> ........ ...a <br /> Inspate ....................................... ........ ....... ........... . . <br /> Zoning <br /> Admi strator <br /> NOTE: A preliminary site inspection must be made a site approval granted on all structures tvolving sanitary facilitics <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatio test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl mbing 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 he Zoning Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />