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3�31/73 yi <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 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 m i <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ..../Fo.bc.r...T......,a......R..u..r....d.A s..h................. .............�.cll... ...siI....... <br /> ........................................ <br /> OWNER (please print) CONTRACTOR or SEVOR or AGENT a <br /> VVVVVV <br /> m <br /> ..!4..93.'s .....��.A.T U. ..... .r ............................................................................................ a <br /> ADDRESS ADDRESS <br /> .a14.AI.1R.. .v..!.!-L. .....w.:.....s.,3sA3.—............. . .......................................................................................... <br /> ADDRESS ADDRESS 1 <br /> . ..8. ...8.6.8..'.7'¢.4.a.......................................... ............................................................................................ �' <br /> PHONE PHONE \ 2�0 <br /> n �V i <br /> ?..... .N.a.�r..K.�Ns.....s...!?.,x. 1.1...G.r..! .y.e.l............ ............................................................................................ ;In <br /> PLUMBER WELL DRILLER <br /> w.�...b...s.Z.4.r...w.! o <br /> ADDRESS ADDRESS n O W <br /> ............. . . . ...................................... ...................... ............................................................................................ O <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: r ° o O <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •• •" ta: c <br /> New Building .,..v Type of Co strut 'on: No. Bedrooms <br /> Addition Septic Tank Size Gals. 73.:.V <br /> .......... ........................... ... <br /> / -.........^... ..t. ...... <br /> Sanitary Size ... .... f � . <br /> „(./, hl...�.. ft. x ....,�.(/... ft. ; <br /> Filling/Grading .......... Height............. Stories ...... . ...... 4a. Absorption Field Site: rn (A <br /> •c f V„�, � Soil Type A i \ `' r <br /> Moving .......... Area�4.:t.i.r:C:. .'.K.......�...�ll... .................................... <br /> }} 0 <br /> Mobile Home J Slope .......................................... L'k <br /> Privy ,,,,,,,,,,/ 3. Use (describe exact) 1 -family <br /> Perc. Rate ................................... J� ' <br /> Well ...,,,,.., home,garage, motel, etc. Dry Well .......... `O I <br /> SubdivisionSeepage Trench .......... t <br /> Camping Unit .......... Privy.................................................... ..... <br /> Seepage Bed ......... <br /> ____________________________________________________________ O \ N <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road P <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- cu <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING .B <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. tj <br /> O <br /> p <br /> _____________________________________________________________________ 1�A <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .AI..... ft. x ..w3..7 ... ft. — ....1�..-j5..f........ sq.ft. .....My. ..S.T..G.t'y!..... iilll................................ \ i <br /> O� J. Ijv J <br /> N Q O <br /> A t w !� <br /> Dcj'•eLL �► `� o <br /> "d � <br /> 7,5 1 . <br /> i <br /> mPSTe.y 0 <br /> 0 <br /> I-AICe <br /> t- <br /> fir' 9A4'� <br /> r� C m d C 0 <br /> l m <br /> Z 05 D a m <br /> OiO o 3 <br /> �. <br /> on <br /> iGJ O o <br /> �. ........................ S-S.. S6............ - <br /> a m <br /> Signature f Owner or Agent / Date x <br /> Remarks-l..C�/ ";. n ...1.��...79.................................................................................................................. mm <br /> A <br /> . :C <br /> Inspection Date ...��... g.. �......... �/� "........... ( ` L' " o 0 4� m <br /> .... ............. g v, 8 <br /> Zoning Adminis ator . . 8 8 8 8 8 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 cusiAtart any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the inform atioii conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> i� <br />