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�Tl , f. 7j <br /> r � <br /> Burnett County Office of Zoning Administrator on o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c, ;v <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ec ?. rte\ <br /> ...... <br /> .............. ........................I..................... <br /> OWNER (Please print) ,CION/T'R A/CTOJR,or S/U R�VEVO orr�AGEgNT a <br /> ........ ....... ........... atS�Qi� <br /> ADDRESS ADDRESS <br /> ........... ............................................................................... ADDRES.S. . .. ...................................................................... V <br /> ADDRESS <br /> ........................................................... C\^ <br /> PHONE PHONE itt, i y( <br /> ........................................................................................... E' ..................................................................................... Z 11JJ <br /> PLUMBER WELL DRILLER i <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS 0 <br /> o <br /> ........................................................................................... .P.HHO"0. NE..................................................................................... O .. <br /> PHONE Z r, <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1, Work: 2. New Building Details No. Bathrooms ' o <br /> New Building .......... Type of Construction: No. Bedrooms .......... 'c <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> .......... <br /> Sanitary Size ft. x ft. •"......• <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... Slope .......................................... -� <br /> PrivPere. Rate ................................... i <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision v.......... Seepage Trench .......... <br /> .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> .......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road e <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 a <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. vl <br /> o' <br /> --------------------------------------------------------------- ---- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> I N o' <br /> O O <br /> rJ ,., 7 j m Eco, <br /> 16 I'J, oi <br /> o <br /> 1.1 lel _)J <br /> ' ipp <br /> _ m <br /> sa <br /> r 9 : m Z <br /> c <br /> £ <br /> w m <br /> �, m <br /> Z a <br /> 0 0 n ' 70 <br /> in - tO 3 <br /> 0 m <br /> ............... ........................................................... <br /> ......... ............................ :V o C <br /> Signature of Owner <br /> ior Agent466, <br /> / D Date X <br /> Remarks Sw..!-'' 46(/.,x,'.`..7// <br /> ........................................................................................................................ 0 <br /> m <br /> En <br /> ........................................................................................................ .. . .� . . . . <br /> //��.................... . . iXp' <br /> Inspection Date ....................................... �... . . ........... ............................. m <br /> ✓lI ............:.......... .. . . ............... o omo $ $ in rn om <br /> Zoning Admini trator '4d . . S $ 8 $ rn <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, da 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 />