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l?C2p�tom. <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N M <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i\ <br /> ... .W." ...... Q..".".. ........................ .`.. .... M.................................................. <br /> O <br /> OWNER (please panL.t) CONTikACTOR or SURVEYOR or AGENT o. <br /> 1k..34. .�- <br /> � ... .t�!1�1e ..V�. .O.�..........�.................. ...... S Q ..... �...SL.................................... a <br /> ADD ESS ADDRESS <br /> .....'m..�.N ....................... ............................................................................................ <br /> ADDRESS, ADDRESS i y9.f <br /> ..............5.5....4.1...................................................... ............................................................................................ <br /> PHONE <br /> PHpNE.�.lol..~.. •..��...J.J.4. \,............................ S 1�.ASC�.................................................................. <br /> PL\UMBER WELL DRILLER <br /> O <br /> ........................................................................................... .AD.. ... ........RES.............................................................................. —. <br /> ADDRESS DS n 0 <br /> n O <br /> n <br /> ........................................................................................... ............................................................................................ o .. <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: 0 8 0 <br /> 1. Work: <br /> 2. New Building DetailsNo. Bathrooms • •"••• is i o p(�, <br /> New Buildin ,.✓, Type of Construction: No. Bedrooms .......... 3 <br /> Ad on Septic Tank Size Gals. .......... pi <br /> .......... ......(... .................. . . <br /> Sanitary .......... S"iz"e' <br /> ize .1 A...... f.. x . 1C1 .... fi. """'"' F' ' <br /> 11 <br /> Filling/Grading ,...,.,... Height..... � �ortes . <br /> 4a. Absorption Field Site: <br /> Moving .......... Area ............ Soil Type .................................... lit; <br /> O <br /> Mobile Home Slope .......................................... t4 .. <br /> Privy .......... 3. Use (describe exai familylVo Pere. Rate ................................... — i <br /> Well Dil Dry Well .......... I i <br /> .......... <br /> home,garage, motel, etc.) t <br /> Subdivision .......... Seepage Trench .......... <br /> .................................................... H <br /> --Camping Unit— Privy .......... <br /> W <br /> Seepage Bed .......... i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road (� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a A <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING N3 <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: M <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> 01w <br /> p <br /> 00 <br /> €W <br /> 0 <br /> F <br /> G r —X I.$r • � � <br /> V �Qp x :may <br /> I <br /> ItS z+-?.t* f p fsrr��� o <br /> � r'1> �ttmQosrd � kA � <br /> (Y Meuse f � <br /> 4 <br /> Cl- <br /> �xtA" <br /> ( � � � <br /> n Q = < m B E m y F a � mam <br /> me m : : <br /> O Z 0 3 . n n 71 <br /> V 9 <br /> dov' so <br /> 0 <br /> a <br /> ...................................... <br /> 0 <br /> Signature f Owner or Agent Date Q x � <br /> Remarks .. u!G ...#.1 .7..��....9.....//.......................................................................................... T m <br /> v <br /> 31 II <br /> ..................................................................................................... ... ...................... .......9...............,............................. . . . . . <br /> �} Id m <br /> Inspection Date ....................................... Gf l)G4�......:..... ... o: U N N, <br /> Zonin Adm✓ �J 888888tmn <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 he attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, on any plumbing or Start any budd- <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />