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Burnett Cot it;'� Office of Zoning Administrator v JZ <br /> o p <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '- 3 f <br /> TO.THE'ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> © V <br /> .1.4..6.az,r�.........ky.n.i4....................... ......\..� �....�.a..�J.Srt....�.Q.................................... <br /> 3 � ° <br /> OWN Rlple.se print) CONTRACTOR or SURVEYOR Y AGENTm m <br /> m <br /> .. 1.......h1.e.R .a. .... ........................... 1�,'�.`..bs...j. .�+.......`.'� <br /> ADDRESS ` ..... 4 e' ADDRESS .. ... lel\ �K.L�7...4r.................................. <br /> ADDRESS .... Q ...D......... .............................................................................. <br /> J '/D ADDRESS � r ' <br /> .. <br /> PHONE............ .. ..... . ............... ....... .PHONE....................... ........................................................ <br /> ilk <br /> I.-. .1. ....- .. ' ..-..�..5 3.s............................. ............16. 6 <br /> PLU BER . w •� <br /> A..I.. .. <br /> WELL DRILLE :� <br /> ADDRESS ........ . ............................................. <br /> ADDRESS <br /> PHONE .................................................... . .......................................................................................... p ,.; <br /> PHONE <br /> DESCRIPTION Z r <br /> 1. Work: 4. Sanitary Facilities: ° 0I� <br /> 2. New Building Details No. Bathrooms <br /> New Building Type f Con$tr coon: No. Bedrooms .. �° <br /> G k <br /> Addition D p xa v1 Septic Tank Size Gals. ...,GDO :N a <br /> Sanitary Yya •• .� < <br /> -1, Size ... ft. x ....T.. .... ft. ...... . :� i <br /> RIIlingfcrading Hei ht..? . . Stories .....1........ 4a. Absorption Field Site: <br /> Moving g ••• Q <br /> .......... Area ...........y.p.Q..................... Soil Type .................................... <br /> r <br /> Mobilo Home Slope .......................................... a o <br /> Privy 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> \' i <br /> ..�1.....: ho e,garage, motel, etc.) Dry Well <br /> Well y ; <br /> Subdivision •T <br /> n <br /> (Z p Seepage Trench n <br /> Camping Unit .......... Nd... .•• • . .Q.�. .................... <br /> —————————— ------- ------------g...... Seepage Bed o <br /> — ____________________ o3 <br /> r <br /> Location of proposed structures and existing structures,well,sewage systems, roads etc., should be sketched in Fig. A. Include road 'may, Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property W <br /> p p y is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTINGL d . <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o .� o; <br /> ________________________________ <br /> <� <br /> 5. Lot Size: Fig. A. 6. Location: � :v i.ro !LA <br /> ft. x .............. ft. — sq.ft. ...... w itt <br /> ..................................................................... °o f tti alb <br /> i�Gl'e5 5004 —INoR R <br /> w <br /> :Vt p <br /> N o i 0 <br /> p' :SL> <br /> ISo � <br /> E r f 44� ,i f o <br /> b r a o <br /> j ­ a <br /> ISX3So fano 1� i2aot>, I lc io <br />•iIH 00o <br /> tagW M <br /> I <br /> C V <br /> e f MCn 13 mmZ <br /> y p V'cr 0 m E. E <br /> LP Kx1 a <br /> m : <br /> o 01 <br /> ..... ...................... 5� A P� m <br /> g `� l c <br /> Signa re of Owner or A ent "... .......... �� ' <br /> � ` /� •.•Date : o <br /> Remarks�tl�.�'l�//,yµ�. .w� .r a, 4�rv....... X 70 <br /> 6' <br /> :../1�...�..C..rzr /.. .�7�. ...... <br /> 0 <br /> ... ................................................. <br /> ce <br />.................................. <br />............. ................... ..................... <br /> ................................ <br /> Inspection Date ���^ <br /> n <br /> P ....................................... . ..... <br /> onin Administrator <br /> IOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />'ris application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> Ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br />�ith is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />