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,X-7-)6e-'-)k9. <br /> Burnett County Office of Zoning Administrator T o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3, o <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 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i :bj <br /> .a�.G.......KESSILIllR:................................... ...,(1�E? !�TN��9.VO.....�!i/LpE�....:TiVC � � v � <br /> M <br /> OWNER (please printI CONTRACTOR or SURVEYOR or AGENT o. <br /> l <br /> 7f. 4 like <br /> ADDRESS ADDRESS - <br /> NE/ /01AW <br /> .. .... .... .. ............. . .. SSJ1A ej_)1s e. syit <br /> .y.......... ......... ........ <br /> ADDRESS .ADDRESS .......i . .... <br /> EC. <br /> YFO-L <br /> ....................................................................4... ...4.......7!...'.1.'�.y-.3..'t1e9 <br /> PHONE................................................................................ PHONE <br /> . . . ... ............................................................................................ :� <br /> PLUMBER WELL DRILLER <br /> O <br /> .......... <br /> ........................................................................................... .................................................................................. - <br /> ADDRESS ADDRESS n o <br /> ........................................................................................... ............................................................................................ o' <br /> it <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: / ° o ° <br /> 1. Work: No. Bathrooms v <br /> {, 2. New Building Details I <br /> New Building .,,i1, Type of Constructi No. Bedrooms ..2'... <br /> Addition .......... f Septic Tank Size Gals. .......... <br /> Sanitary .......... Size t. x .. :6..... ft. ......... <br /> Fillingf Grading .......... Height. .... Stories ..../........ 4a. Absorption Field Site: <br /> Moving ......4... Area ........//.y Soil Type .................................... r <br /> Mobile Home Slope .......................................... o <br /> Privy , , 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> 1Y Dry Well <br /> Well <br /> .!x....., home,garage, motel, etc.) .... ..•• <br /> Subdivision .......... ; FAM/wY.,., �M,E.... Seepage Trench .......... F <br /> Camping Unit .......... Privy .......... <br /> .................................................... . <br /> Seepage Bed ......- on :(_ <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> p d t <br /> setback, side and back yard dimension and location and setback from all bodies of water. If 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. H: <br /> --------------------------------- ----- -- --------- — r� i <br /> 5. Lot Size: Fig. A. 6. Loc tion: <br /> 1. .... ft. x ��..... ft. — ..9I o c............. sq.ft. ... /PidSBT....�.$K� <br /> �( 44 o <br /> ,\ J m <br /> _ <br /> / 77 N r m d 0 Z <br /> Fc <br /> n C <br /> Z oo' � Dam�is�/'SEi lid C� 9 _ . a m 3 <br /> on <br /> I <br /> p <br /> 3%b-P1H w <br /> Signature of Owner or Agent Date <br /> f hr 3 P2 r x 7D <br /> Remarks .....Q.mr......C.S-.kY:Dk.:: . ., o- L 5.f G�?�.t?./L:g.e ,5...�da tr 3 .. 7% �..�.':��:" y.............. T : M <br /> II <br /> U , <br /> _ N � m � Nm <br /> ......................................... <br /> Inspection Date ....................................... .. ..... . ... 1, ,,,,'�,__ ...................... ° o v, o u, o Pr y <br /> Zon g Administrator 8 8 $,$ $ $,. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitles\ <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 he made without approval of the Zoning Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />