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05/18/2005 08:06 3492166 B C ZONING PAGE 01
<br /> BurnMt County n if'
<br /> APPLICATION FOR SANITARY , LAND USE � IDI Of PER Administrator
<br /> Ter THE ZONING ADMINISTRATOR:The and B ILDING PERMIT yy
<br /> sham hewln,Tha antlaraipned a NSiarred heraev mekas aopllae[ian far a Perm t IOr N
<br /> Ordlnanyca.SanigtlOn Cada.
<br /> and wi}h thin
<br /> be dq,Orr;1R In accordance wiM the a work deseribM and located as a
<br /> H o arrive M. nu or rho Bvrna[t County lacy Ur
<br /> nags and
<br /> tha laws •eel.latlont of me ST
<br /> ... n7 i at!0(Wisconsin4 G
<br /> OWNER°Itaae printf.. ./�,�............. /.42A
<br /> CONTRACTOR O. ....... ....................
<br /> 9 O
<br /> SURV YOR Or AGENT -• ----"""
<br /> ADD -7
<br /> ........ ...............I.......
<br /> lr•.,� �'•c�II ADDRESS .............................................
<br /> ADDR�Sg '1.,:...n.A.1..IL.p./.l.lr�✓.�.t.:...y.-N.FF
<br /> /' �s A bD R E 53 .....................................
<br /> ) %a`
<br /> PN NE ...,....., '
<br /> .. PHONE.............................................................................. i
<br /> PL.....,,... s
<br /> ................................ l
<br /> ..........................
<br /> wELL DRILLER ..................................
<br /> AOORE5 'r4.......................................
<br /> i
<br /> ADO RE$S ....................................
<br /> .......................f.
<br /> DESCRIPTION Sr d
<br /> 1. work: 6. nitary Rxilitiec: F c s
<br /> Naw Building
<br /> Z• New Building Details o.Bathrooms -
<br /> .,.At•. TVPe of Construction: o.Bedroom°. -. . . . .
<br /> Addition ---. ,. '� 'I
<br /> -"'�'a N.••••- Ptic Tank Site GOTS.
<br /> sanitary � /�{'^� }� ..., .......... i
<br /> Flllln IG -.•"k'.-. Sita.CLLR.••.. ft.x.3b,...•ft. `.� t. '
<br /> P `°slog Height..,,,,, 1,U•,• rptlon Field Site:
<br /> Moving .-...•,••. Stories... 4a. bso i I
<br /> Mobile Hama Area ....I.�Q/,...SG.E ,........ it Type....................................
<br /> lope.......................................... gs e
<br /> wavy 3, Use (describe exactly,t-family etc.Rate.........
<br /> Wall home, of i
<br /> 9ytMlvlalOn I
<br /> S age,maeJ,ttc.l ry Well '
<br /> Camping Unit -5'� L.•uz+kx.r N etsoge Trench
<br /> Ivy i
<br /> _—__—_— •ePage Bed �' i
<br /> setback,Local'"Of praPOKd slructurM and existing structures wall.
<br /> aide and laaOk vartl dirrwnAan and location and WivAch ylf sniemx„rads-etc.,sneulO skltchatl in Fla.A Intl udw rosy
<br /> watian,thaw tha ilstnrMiling ryiyhweys and tha w,beeks aCk tram all bodles Of water,11 Property is Incatad at a hi hwaY Inter
<br /> --'_— --_--~ — req,fir.y slang Ihrm and at the IntOnact an.CLEARLY LABEL EXISTING ; 41 �,
<br /> STRUCTURES ANO PRUPOSED STRUCTURES AND ADDITIONS.
<br /> _—__—_^
<br /> ^— —__— _
<br /> 5, Lot Size! -- •--_—__ t
<br /> --- —�---------
<br /> Fig A. 6. Location: '---•`-- 0I
<br /> n.x h.-
<br /> ............_. rz,S try.
<br /> tK
<br /> W
<br /> r y
<br /> a d
<br /> Sir
<br /> r - is
<br /> 1 �l
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<br /> 9
<br /> C �'
<br /> rnt
<br /> may + 37a
<br /> Ao
<br /> ..19ma............ p �. - ti-4-87..
<br /> It
<br /> Fin
<br /> Signature of Owner ..•,••......
<br /> Dote l b
<br /> Remarks IJ
<br /> ......................................................................................... ..... X
<br /> .... ........................................ r ,
<br /> ' 4
<br /> .....................................................
<br /> Inspection Data . .......... ' 'i`Y
<br /> ZOdi•••. ,•miflietrator••••..•••••._•••••. p'v
<br /> OTE! A Preliminary she Inspeenan must be made and site a g i 8 lJ'
<br /> store Construction can begin. In the tate of cower° a disposal Proval ranfpo on all structures involving sanifary faeitlties
<br /> Ill application before a permit will be issued, psystems,a copy of the Percolation test must be httached to
<br /> g until a permit has been issued,q DO not purchase or install a ups c tank,do an
<br /> permit may be revoked if misreuresentaun y Plumbing or start Ony build
<br /> ith is Tound t0 exist, Changes in plans or spCCil be ren II Of any of lite information coeive
<br /> SEWER SYSTEM SHALL NOT S s all not h4 Marie witlhout approval of the Zonlnt nail here-
<br /> BE COVERED UNTIL INSPECTED BY THISJAtlm inislratol,
<br /> OFFICE AND APPROVED. '
<br /> I
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