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Nyic <br /> unty Office of Zoning Administrator i 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> o ?v <br /> ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein, Thew nderslg red agrees that all work shall be done In accordance with the requremen is of the Burnett County Land Use C <br /> Ordinance, Sanitation Code,^ands with all other applicable County Ordinances and the laws and <br /> regulations of the, State of Wisconsin. a <br /> RIJ.� .///........��c&...�../.............................................. ..........�l ciA— ....C.y .�..s.!...!....�..r�YD.............. � � � f <br /> OWNER (Please print) / CONTRACTOR or SURVEYOR °r AGENT Q <br /> -f- <br /> �f..a..S.......eld..w.�..... ......S / ....................... <br /> DURESS 0 ,/ p ADDRESS <br /> I. ''QJ .........'5..�.....® 6W L X11 '1 . �.�/�O \\\ ^w <br /> 1/.4f......... ............................................... <br /> ADDRESS . .......................................................................................... <br /> ADDRESS � � a <br /> ......................... ................................................................. ............................................................................................ <br /> PH4E PHONE <br /> ...................................................... . ...... II-'E ........... <br /> ...... <br /> .......... <br /> ....... <br /> ..... <br /> ........ <br /> .......... <br /> ............ <br /> PLUMBER ................................................................. WELL DRILLER.................................................................... <br /> ................................. ........................ O �h <br /> ADDRESS ADDRESS G) <br /> n ° <br /> PHONE PHONE <br /> DESCRIPTIONr- <br /> 4. Sanitary Facilities: � R o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... :,C 0 <br /> New Building ....�� Type of nstruction: No. Bedrooms .. -:.. A <br /> Addition ...•.,•_ h 4 OVA*e Septic Tank Size Gals. ........� <br /> Sanitary .:� Size .... ft. x ...3.�a... ft. 7 .... '•� <br /> Filling/Grading ..... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r- <br /> .p <br /> Mobile Home . ........ Slope .................... ..................... � .. <br /> o u <br /> °rive .......... 3. Use (describe exactly 1 -famil DryPaidRate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... p <br /> �/. See <br /> Subdivision ,,,,,,,,,, 9[L'f �Gse�rc•<< page Trench „s <br /> Camping Unit ,,,,,,,,., Privy A <br /> ------------ ------- --------- ..... Seepage Bed /aX u <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched in Fig A. Include road on <br /> setback, side and back Yard dirnen sion and location and setback from all bodies of water_ If property is located at a highway inter- z °. <br /> section, show the intersecting highways and the setbacks required alonq them and at the intersection. CLEARLY LABEL EXISTING W ;� <br /> ST RUCTURFS AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---- ---------------------- 'A ! :� <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq. ft. ............................................................................... <br /> N W <br /> ° <br /> LV <br /> 0 <br /> w' t4A}. <br /> r • �� �T��Tu:ol :T -p <br /> V . •, <br /> . �� D�e�O` 31, p o V�r <br /> 1`� 9 <br /> $JZ �Sp y 7J V r v o m <br /> nLaw <br /> Q < m c m <br /> F <br /> i t8x�y ti< <br /> Sm <br /> o a = � <br /> ' <br /> 3 <br /> /'�,�� rn <br /> R' o <br /> Signature of Owner or Age t Date V: _ <br /> X 7] <br /> Remarks ......................................................................................................................................................................... m m <br /> O <br /> ........................................................................................................................................................................................ 69 <br /> W: <br /> Inspection Date ....................................... 2TGL0.. . ........./....:Y........... ...? ................................�............ . �: 8, u � o N o m <br /> Zoning Admior rj $ $ 8 8 8 8 vmi <br /> NOTE: A preliminary site Inspection must be made and site approval granted on ell 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 />