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Burnett County Office of Zoning Administrator as, <br /> 0r o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT - 3. _ <br /> < ,. o <br /> TO THE ZONING ADNMNISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as _ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - C :-L <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> V.1.. ........Sc F.. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> '7? wovill Yrv� <br /> ............. . ?? �t . .............................................................................. a <br /> ADDRESS ADDRESS <br /> .....SSI.!.c�- ..... <br /> ADDRESS ADDRESS <br /> 1 ?;i <br /> PHONE........................ ......... ........................................ .PHONE................................................................................ :.1� <br /> /S h 0�e f !— -1 <br /> i �p € <br /> 1. /..:........................................ ............................................................................................ i� i <br /> PLUM : ....... ........................ <br /> BER WELL DRILLER <br /> I�1.e. .Sr...,....W.`.s.......... <br /> v�y o <br /> �.I . <br /> ADDREESSS/ /' ADDRESS i m o <br /> 6 (ft fT— o' �. <br /> ........................................................•.................................. .PHONE.................................................. ....................................... <br /> PHONE � <br /> H <br /> DESCRIPTION 4. SanitaryFacilities: i z o ° ' <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details �•"••"•' ` "� o <br /> New Building .......... Type of Construction: No. Bedrooms ... _ as <br /> Se tic Tank Size Gals. .......... <br /> Addition .......... ....... ............................................ < <br /> Sanitary Size ft. x ft. �� g — •Z <br /> FillingiGrading .,,.,.,.,. Height............. Stories ............... 4a. AbsorptiorT ield Site: G <br /> Moving ....... Area ........................................... <br /> Soil Type .................................... v : <br /> Mobile ro <br /> HomeSlope .......................................... <br /> Privy ,,........ 3. Us escribe exactly 1 -fa Pope. Rate ................................... . <br /> Well .......... ome arage, motel, etc. Dry Well .......... T -177 <br /> subdivision .......... .................................................... Seepage Trench ....._... <br /> CampingUnit ......... ...................................I................ <br /> Seepage Bed .......... <br /> 9 '`t <br /> an <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc_,should be sketched in Fig. A_ Include road f rn <br /> Q <br /> setback, side and back Yard dimension and location and setback from all bodies of water_ If property is located at a highway inter- r 7 n <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. o <br /> ------------------------------------------------ --------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ki 2f on <br /> is : w <br /> IN <br /> x <br /> � <br /> 0 <br /> � V <br /> z <br /> O <br /> Q <br /> Al I A <br /> 7JN r V n m Z <br /> ' < N <br /> n Q � < � � E' F <br /> M <br /> N a <br /> N d m <br /> Dam <br /> 0 o o n 70 <br /> o n <br /> EA <br /> x�� m <br /> 3—F7 s p <br /> .. ............. ' o C: <br /> Signature of Owner 'r Agent Date — <br /> ,�}� / X 70 <br /> Remarks .C./... . �'`.1...�..rG! .''�F— ' T m <br /> m <br /> e» <br /> .................................................................................................................................. : <br /> Inspection Date ...J�.. _ —.K'. � `'(I,r..f,l' 'Zoning AdTmini'skr tor'•�� 1f�1 g o o �'o m <br /> ..... ...... ....... ..... <br /> o moo fn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary feet iti ., <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 /> ung 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 Ife made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />