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Burnett County Office of Zoning Administrator Z' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> 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 C •_ <br /> Or 'nance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> �t.r..�c.K.......... . .kale............................... ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> 1..9. 1. ......1.3.1. r...... ....N............................... ............................................................................................ d `� <br /> ADDRESS ADDRESS .. <br /> S.; <br /> � 1 <br /> slil.kIWATEE.t.......&A)�?.........a. ..... ............................................................................................ <br /> ADDRESS ADDRESS <br /> �b <br /> PHONE PHONE <br /> .. ...... . ............................................................................... . ...... . .. . ....................................................................... '� <br /> PLUMBER WELLDRILLER :6 . <br /> .......... <br /> .ADD........R...ES...................................................................... <br /> ADDRESS S o N <br /> m � <br /> . . .................................................................... ............................................................................................ ? <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: o S 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> .......... n <br /> New Building No. Bedrooms <br /> .......... Type of Construction: • • <br /> Addition .......... .................................................... : < <br /> Sanitary Size ft. x ft. •. ••••••• <br /> FII11 ng l Grad Ing „ .•.,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... � i <br /> ........................................... o <br /> Mobile Home .......... Slope .......................................... N <br /> Pend. Rate ................................... <br /> Privy ........•. 3. Use (describe exactly, 1 -family , <br /> well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... i <br /> .................................................... vt i <br /> Camping Unit ..x... .................................................... Privy .......... O <br /> Seepage Bed ......... : ! E q <br /> ----------------------------------------------------- o to Op� <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter oa-, <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING viii <br /> 411(, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0�111IIIG o” a <br /> 5. Lot Size: Fig. A. 6. Location: <br /> F <br /> Land Use Camping Permit from July 10, 1986 to January 10, 1987 <br /> I tw a <br /> a <br /> n r m 2 m m z m F E. F <br /> 'o NNiac: 0 n m -0 <br /> � m <br /> Z o o : D o m <br /> 0 0 Da m 3 <br /> W o <br /> � [ m <br /> ....... ....... <br /> 0 <br /> 71c.a.�. .. ...... <br /> s� <br /> � o C <br /> Signature of Owner or Agent Date \X <br /> Remarks ......................................................................................................................................................................... T m <br /> ........................................................................................................................................................................................ II <br /> ........................................................................................................... ..... ................. ?�1 <br /> . ........ .. <br /> ................................. T <br /> Inspection Date ....................................... ...... .. . .. 1�.`............................... o 'o m <br /> m <br /> Zoning Ad istrator �$ 8 $ $ $ $ to <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, 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 Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> i� <br />