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G )1 0110/1 � t <br /> Burnett County Office of Zoning Administ ator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and lot ted as < u, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County La A Use ' <br /> Ord i ante, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of th tate of Wis onsin. 3 a lJ <br /> ° T C 1 i <br /> .L.....QF�� ...... .. . ......................................... .. .!.P�...('�} ..(��..9. ,.ne ...............'...... >.�r, u. o <br /> OWkN E1R (please printt���7�y CONTRACTOR or 3U 5](EVOR or AGE NT a A <br /> ....�11. .4.a....C7�.. .i...7r.6U/\....L a... .......K....Ve: ....4,y. .r................... ......... a <br /> ADDRESS AD SS <br /> ll _ '1 ,... ..................0.............. ......... <br /> ADDRESS ADDRE S <br /> PHONE................................................................................ .PHONE................................................................... ....... <br /> ........................................................................................... .W..ELL D............RI..LLE.... R....................................................................... <br /> PLUMBER <br /> ADDRESS <br /> ..R"ES".............................................................................. <br /> ADDRESS m L1 <br /> o w <br /> ........................................................................................... <br /> PHONE PHONE Z N <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building No. Bedrooms .......Type of Construction: <br /> mPQ <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x .............. ft. •..••.•.• <br /> FillingfGrading ,.,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ......................... .......... r i <br /> c� o <br /> Mobile Home Slope ............................... .......... �� <br /> .......... U6 i <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ........................ .......... <br /> Well , .... „ home,garage, motel, etc.) Dry Well .......... <br /> \/ <br /> Subdivision „ Seepage Trench <br /> Camping Unit .......... .......................... . .................... s i' <br /> i <br /> Seepage Bed <br /> .......... 1 i i <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Incluile road j <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highwiry inter- <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Jai — <br /> 0 <br /> rl i J <br /> 5. Lot Size: Fig. A. 6. Location: " <br /> ................ ft. x .............. ft. . ............................... sq.ft. ................................................................... .........., <br /> 4ac �Pd C'S/�-t <br /> Vol . 11 P <br /> Io <br /> �o <br /> Y : <br /> pip <br /> 1^ \or\ T <br /> J ` m <br /> Limm <br /> J <br /> M1 <br /> W <br /> m <br /> Z o N D a m <br /> 3 EA — <br /> m <br /> M <br /> pigof Owner or Agent Date C <br /> I <br /> �X 1711� <br /> Remarks ....Cr..,,.... �' O <br /> ........ .... <br /> ................. Q... .i .... � ��' .. .. � ................................................................... ....... <br /> ................................................................................................... C ..... AA/ <br /> Tm <br /> Inspection Date ....................................... m, �. ... <br /> Zoning Admin ator B 0 0 6 0 6 o y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures i evolving 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 />