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Burnett County Office of Zoning Administrator W M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3. _ :\ <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N µ <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 /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i� ix <br /> . . ..( .ar.d......... .m.i< ...................... ..... .... . .s .... . .................................... <br /> kQ <br /> — <br /> 0- ° <br /> d O <br /> 0 (please print) CONTRACTOR or SURVEYOR AGENT <br /> � T <br /> .. � T.......�1.!Oka.t4J.....1�a � .. ......... .bs.fi�r......u?.►.5. <br /> ADDRESS ....... <br /> ADDRESS <br /> MI.......... ............................................................................................m ..... � 0 <br /> ADDRESS •+ <br /> siL <br /> r . <br /> ,�O y0/ ADDRESS V � <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE A <br /> I..-. .1. ....- . ..-.. . .3.. .............................. ............g.6..6..-..... ...1... . ........................................... <br /> PLUMBER WELL DRILLE <br /> .......K o .��r................................................. ...... ..-..... �r. .fl. ......................................... r .o <br /> ADDRESS ADDRESS m .O !'� <br /> 0 0 <br /> :bsItr 3 <br /> ............. M <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o '° <br /> No. Bathrooms <br /> .r <br /> � <br /> 1. Work: 2. New Building Details . <br /> New Building —�...... Type f Con tr ction: No. Bedrooms k .. <br /> Addition ,,,, I Septic Tank Size Gals. ...b9n V <br /> ......... o.o ...�.r.a.rya ` <br /> Sanitary +..... Size ... ft. x ...:7. :... ft. C <br /> Pilling/Grading .......... Height.. ...... Stories .....�......... 4a. Absorption Field Site: is <br /> �.�.Q..................... Soil Type .................................... m <br /> Moving .......... Area ........... 'r, x`1 0 <br /> Mobile Home Slope .......................................... l 6 <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... < i <br /> Well �1hoe,garage, motel, etc. Dry Well ........,. ; <br /> 9 T <br /> pp .yLL Seepage Trench .......... it <br /> Subdivision .......... '.:.C.4M.IL .R.�.I.74.....�.0. h o <br /> Camping Unit 4.... (� .. Privy .......... U <br /> P 9 .......... 00.4A... ..... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures well sewage systems, roads etc., should be sketched in Fig A. Include roadpi p C <br /> ci- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter" V 't> °- <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. d o" <br /> AA <br /> 5. Lot Size: Fig. A. 6. Location: r` jjl <br /> ................ ft. x .............. ft ............................... sq.ft. ...... ................................................... . ° t'tt al <br /> g AGl'eS X004 LtTit c R � w� <br /> N In:1 o <br /> . <br /> r� -- 44 — T <br /> s <br /> l �X3s� ,a o`. 1 Room F <br /> C� Z <br /> o '° <br /> J <br /> Ifo s <br /> `PYI ._ .4"t 6'.L¢. Ra PA <br /> N r - W M Z <br /> n Q < c m <br /> F <br /> F— y <br /> p G <br /> ... .... . ............... . ... ... ........ . ....... ............. .............. ... ... . o C <br /> m <br /> Signa re of Owner or Agent / Date — <br /> Remarkstr7.r�✓.LL,:?,ktu.f. `.4!.�c.f. rs:.e ... ? .. .. .,{: Irv... .t •.! ..�L:. .. tky:u...�L. f.`�{u,cq: re : m <br /> ` ................................................... v <br /> J II <br /> ............................................................................................................ .. ............. .................................................. <br /> InspectionDate ...:................................... ....... ....... .......... . ...................... <br /> Zonin Administrator g o <br /> NOTE: A preliminary site inspection must tie 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 lite 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />