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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> TO THE ZONING ADMINISTRATOR: 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 73 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cc <br /> o <br /> i� <br /> ... uL�I�G ...J/Z . �JJE a <br /> OWNER (please pr��i n//t)t CONTRACTOR or SURVEYOR or AGENT <br /> .. :. F�?.Z 1......!!11✓X <br /> ...!1... . .��'`f ............................................................................................ <br /> ADDRESS ADDRESS '.,1: <br /> !Nf/T€.....per /2 Zg'e''C--/ '... si.�. ...... 'A <br /> ............ ......... .... ...... .... ............. .... . .. .............. • t <br /> ADDRESS DDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE <br /> (J�aN..... .... 0.. . <br /> r..r..................... ............ ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> Irf Z....�.....'��.x �/ c, 0.9/�jl i :............... �i o <br /> ............................................................................ <br /> ADDRESS M r <br /> o <br /> PHONE PHONE Z r iL <br /> DESCRIPTION 4. SanitaryFacilities: o 0 <br /> 1. Work: No. Bathrooms .......... � <br /> 2. New Building Details o o <br /> New Building No. Bedrooms .......... e <br /> ... ...... Type of Construction: �• <br /> Addition ..X.... ........4V.4 'G?. /t.' ........ Septic Tank Size Gals. .......... F ;� f E <br /> Sanitary """"" <br /> ..X.... Size ....y..'..... ft. x .. ....4... ft 4a. Absorption Field Site: <br /> M ; <br /> Filling/Grading ,......... Height.....�.... Storiess .....�......... <br /> Moving Soil .................................... I <br /> . 1 <br /> .......... : r i <br /> o <br /> Mobile Home Slope .......................................... iky .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Fare. Rate ................................... <br /> Well .......... home,garage, motel, etc.) <br /> Dry Well .......... -Z <br /> Subdivision .......... ..••, !��'! •.../t?pp�ll...y/�/>,l/vv Seepage Trench .......... to <br /> Camping Unit .......... Privy .......... � :� <br /> ............................I..................... <br /> __________________________________ Seepage Bed : <br /> ____________ O 'N i(!1 <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc-, should be, sketched in Fig. A. Include road u <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 property is located at a highway 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. p ip O <br /> --------------------------------------------------- <br /> _—_- <br /> 5. Lot Size: _ Fig. A. 6. Location: i\j <br /> ../. E.J..... ft. x .:5- ft. . ............................... sq. ft. ....L?9LcULX y/ }...../.,9!....?. pOLj/7................... E <br /> Sy <br /> (t. <br /> N o <br /> oo <br /> r <br /> � N <br /> €ly 0 <br /> i(A <br /> is <br /> i � s <br /> cS— o n <br /> d <br /> 8'2 x ! ( f? <br /> n r a w <br /> m z <br /> c v c m <br /> m oun< �_ aE <br /> F, 0 S. M <br /> Zo o' n , 70 <br /> FA <br /> j� s -� <br /> . ............. . .......... ....... .. .... ............. ...................................... C <br /> Signature cr wner orr mg . Date yx O 77 <br /> Remarks�/ ..A.C..,.:C:2.r...� Z'!- ..v--� ; : : : m <br /> m : <br /> n <br /> ........................................................................................................................................................................................ <br /> ..................................... .................................................................... ... ........ .�oniAdminist'r'a"t'o'r <br /> \'• ;/` : <br /> Nmpp .. .................................. <br /> Inspection Date .�y..:...,.].L`.'•.-'..6.......... .............. .... ........................... ; `" 0 0 0 $ S m <br /> tor 8 0 0 0 (/� <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 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 />