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C`r 6>— <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> nN� . - d o <br /> �N�tlE � JdNN50A/ � OO V 7` Q <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> lG....li.Ile-sa ........ .. .... .... .. ... ...... a '(A <br /> ..... ...... . .... . ... ...... ...... .... <br /> ADDRESS M ADDRESS <br /> /..!1.Q�:.:!..j..!Al.! .....J/.. .. . . iZ <br /> ... ...... .............................. <br /> ADDRESS ADDRESS <br /> l <br /> .............. <br /> ........................................................................................... .............................................................................. <br /> PHONE PHONE a <br /> ........................................................................................... —E–L' ...R, I'IL.......................................................................... <br /> \ i <br /> PLUMBER WELL DRILLER <br /> G <br /> .......... <br /> .. <br /> .................................................................................. <br /> ADDRESS ADDRESS m G) tZ <br /> ° (n <br /> 5 � :o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> r: v <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> 0 <br /> New Building Type of Construction: No. Bedrooms .......... �: L :�. <br /> m <br /> Addition .. .,.... .............................. ...... Septic Tank Size Gals. ........,. <br /> Sanitary .......... Size ..La?....... ft. x ...�.A...... ft. .......... i <br /> FiuinglGrading ........ Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... C <br /> Mobile Home $OPe .......................................... c� •• <br /> .......... <br /> Privy ...,,,,.., 3. Use (describe exactly, 1 -family Pere. Rate ................................... tj <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> .......... <br /> Subdivision .......... ��yAr�!z Seepage Trench .......... U <br /> —Cam Ping Unit .J 0. .....: 1 `x\ Privy ........_ <br /> .......... .. ... ✓:�.1. ... <br /> ��� Seepage Bed ......... <br /> ------------ -------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A- Include road °RI <br /> sethack, side and back yard dimension and location and setback from all bodies of water. It property is located at a highway inter- O a <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 /> ---------------------------------------------- ll i <br /> 5. Lo Size: 'I Fig. A. 6. Location: i <br /> .�. .I........ ft. x T.J.0.. ft. — ............................... sq. ft. ............................................................................... <br /> n <br /> N O <br /> o ° 0 <br /> x4 0 <br /> ° <br /> N�CISTIvfr � � <br /> T it <br /> A <br /> VDIT0 z <br /> JJ N r L < 0 Z <br /> C N c m <br /> m Nda � <br /> F <br /> 'O < ,� <br /> m <br /> Z 06. <br /> a 70 <br /> O O n 3 <br /> yr - <br /> .... ».. .. - -................ .... .............x,../985 o p <br /> Signature of Owner or Agent ate <br /> YENV7 ,/A . .... l Remarks cSrT .r. ... m <br /> . . . ..... <br /> Aere4AIV.. ✓..�E.44...TRN.Of .... ........... ... <br /> o . <br /> ........................................................................................................ ........................ `� <br /> Inspection Date ....................................... Zl+.�.0. .... � .... . .... .. ............. o N N m <br /> N m r <br /> Zoning Ae dfninistrator 8 6 8 8 8 8 f/r <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 It 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 Admin istratol. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />