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Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use V <br /> Crainn��a anon C&e,,a�yain I8tthh-e e plicable County Ordinances an�he haws and regulations of the State of W7sconsln_ 3 a E/� <br /> ..... . .... ...................... ................................................. _ <br /> j d <br /> OWNS (please print) M� �IL CONTRACTOR or SURVEYOR or AGENT a10 <br /> ...7.. .Q...... .. ee. $.t.e..r..... ..1!c?..��:d......... ....... <br /> ADDR�S KO.` �/I IIL°r Y/J J�J��13 ADDRESS <br /> .�.�. �.........�...o ................................................................................. :� <br /> AD ESS pj� ADDRESS FL <br /> �.b4.�.S....... r4r.�....... . . ......s.sya6. <br /> ................. ......................�.I............ ... .......................................................................................... <br /> PHONE n PHONE <br /> PLUMBER WELL DRILLER <br /> ..... Xj <br /> ............................................................ ..................................................................... ...................... <br /> ADDRESS ... ADDRESS �� O .co <br /> . ....... a..b...... ..........r4...................... ..........................................................r.........�,� . <br /> PHONE PHONEZ r- <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ..... ... r�� o <br /> New Building .... Type of Fenstruction: No. Bedrooms <br /> Addition ,,,,rU^�',', Septic Tank Size Gals. .......... ;6 <br /> 1 (/ <br /> Sanitary ,,, Size ..� Y.. ft. x ...3 ft. "!' <br /> ... 1 <br /> FillingiGrading ....., ... Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type .......... <br /> XMoving ....... . Area ........................... ............... .... <br /> O <br /> Slope .......................................... <br /> Mobile Home ,,,,,,,,,, <br /> Privy ... 3. Use (describe exactly,(-fami P <br /> ..... . etc. Rate ................................... <br /> well home,garage, motel, etc.) Dry Well .......... p T <br /> Seepage Trench """"" CF1 N <br /> Subdivision .......... XQ� M <br /> it <br /> . <br /> Camping Unit .......... ..................... .... .... ..... .......... Privy t'1 <br /> Seepage Bed sb <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched In Fig. A. Include road iit1 cr— :m <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway InterLai <br /> - <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING = <br /> STRUCTURES AND PROPOSED STR SAND ADDITIONS. I �,` o r <br /> 5. Lot Size: Fig. A. 6. Location: h <br /> i— <br /> ................ ft. x .............. ft. r,,... ....................... sq.ft. ............................................................................... <br /> V <br /> N a `A` — <br /> Qe <br /> N —O <br /> AN i b� <br /> pep � l.v <br /> L)�s �s • w r f� Rerc�aL o <br /> C <br /> T <br /> -11h <br /> N <br /> 7s' 0 <br /> d <br /> �7 to r w <br /> Lyh'`e <br /> O T G C <br /> 7. ry . <br /> Z O O D <br /> o � aro 3 <br /> fA <br /> :Q� ca <br /> rn <br /> .�..(iT�l .�.�lE=C�y,yicalcJ........ .,(o...—. o..�...`r......... per.o C <br /> Signature�of Ow"n�r/or Agent gyp, ,{ - , - Date/7 �j p zy <br /> Remarks 'A.U�f,cl!!... 5.. .1.w.!"x-f�'.:".P..!4: ..�Q* ? :r..!-x .f..A-(/.l•.0 Q.4 .�L. .7v..'G'e.:.'�: '.MQ�. '........ se <br /> : m <br /> ............................................................ `) y� -- <br /> '� II <br /> ...............................................................................................................�.y.................... ....... .....................�h................ :D . . . . . <br /> Inspection Date ....................................... .4 ....(........... . . ...................... ' ' u a o umi o of m <br /> Zoning Ad nistrator 8 8 8 8 8 o y <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 lie 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 />