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�. 6 - Office of Zoning Administrator a o 0 <br /> Burnett County 3 <br /> �4FIE, +TION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR'. The undersea. hereby makes a plicadi m fora Pennit for the,work described and located as in W <br /> shown herein. The undersignetl agreas that all work shall he done in accordance with the requirements of the Burnett County Land Use n as :O <br /> Ordinance, Sanitation CWe,and with all other applicable County Ordinances and the laws and regulations of the Stare of Wisconsin. 3 as <br /> n /. = a <br /> L._!�. ?ILLcE....l.� - . ........... ....................12 I- C....................................................._... o <br /> owNER dlhrr a prim) -CONTRACTOR.,SURVEYOR or AGENT a in <br /> ............_Salke.................................................. ............... d v F € <br /> ADDRESS ADDRESS <br /> (pl_Z— -L;65,7`�.,/�(3.2-.1`I3....�w;�) q� <br /> ..................... ... ............. ... ....... . .......................................................................................... :S <br /> ADDRESS AODRE55 : <br /> ..A0 .... .. ......................... ................................................ ............................................................................................ <br /> PHONE Ata,. � _ PHONE <br /> .......�j ? • t . �i <br /> .................. . ...... �......... .. ............._ .................... <br /> PLO I, <br /> WELL ORI LLER <br /> ._._{/(5.� (-�.✓a.C.! .. ` �..� <br /> ............. ._...................................... ._.................................. ............ i� O <br /> J\ADDRESS ADDRESS <br /> in <br /> . ............................. .........:........................ .. .. .......... ... .. ..... .... ...... _ ��_ � �� <br /> .. .. ... . . ......... ..... <br /> PHONE . .. . _ . . . ... _ "PHHOONE = -- <br /> DESCRIPTION 4. Sanitary Facilities:-- '0 <br /> 1. Work: p, New Building Details No. Bathrooms <br /> New BuildingNo. Bedrooms 7r- o (11\v <br /> ...Y,... Type of Construction: ""' <br /> F[zQ Septic Tank Size Gals. .ZSQ, f':v <br /> Addition .......... ............. : <br /> Sanitary ....r... Size ...:Z.1...... R. x ..154...... ft. `" <br /> Filling ........ Height Stories ...I.......... 4a. Absorption Field Site: <br /> W Soil TVP. ..............59:..:�7......... - i :O r i <br /> GrMovingArea y ..... <br /> 1.8.0..................... \fir d <br /> Grading .......... Slope .....................i..V.l%¢......... `l` : <br /> Per.. Rate _.........._.�- 3 !T ' <br /> Mobile Home 3. Use (describe exactly, t family "-- Ct ea : <br /> .......... <br /> Pavy .. ....... home,garage,motel, etc.) y '� <br /> Dr Well .......... 1 � : <br /> Well ....X... e.uu. Fd., 1 Seepage Trench .......... <br /> Subdivision ...... Pr,vY - <br /> ....................... > :o <br /> ..... Seepage Bed <br /> _......- -fdX 2t+ .X <br /> ..... — i <br /> ............ <br /> Localion of proposal structures antl existing structures,well,uwaee systems.roads,etc.,should be sketched in Fig. A. Include mad O <br /> attack, side and back yard dimension and location and setback from all none, of water. if property is located at a below., imer- �1 'tql nUp f <br /> action, show the infersech.,highways and the satbacks required alnne them antl at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. L'•. G p j .' <br /> ______________________________________________________________________ Cs y <br /> 5. Lot Size: _ ,«j �. Fig. A. 6. Location: Bap _ <br /> .:,j.2 ft. x .f'2 2:..... ft <br /> ... UtaJFXi.:-... sq.fL ... iM1..M.i.:1s.SEf..T..1.t.SE_Y9.r <br /> T. AO N, R,IS 41 Tr:w.-r me je'e,.',J a <br /> �-crU Lr11t-r— V <br /> Y zv• Z7- - ?' o ' <br /> Fit <br /> 5,v' <br /> \ 0 - F - moi r I o A . <br /> f QtJD �ti LJStL„ we <br /> Alla� i y.7 :� I <br /> / . y p �r� �rnwz <br /> 1 / n <br /> _< <br /> wc> >. <br /> 1 m Nc <br /> re s <br /> o _ \ <br /> 2 ...Q........Z�z21S� `I <br /> 10 <br /> C, <br /> Signature of Owne. or Agent Date <br /> i x <br /> RemarksO�l... f.�_GL,i G/.'.... m : <br /> sk <br /> ..............//.J//.J . ......./../........./..........................................................................................�...............:........... - <br /> .._:......L .C./..LZ1K.cs-sr..L6...C1GF? Rc�..................................... .............. . .. <br /> ......:�/„� .J �.... <br /> ......'.."...i'................. <br /> Inspection Date <br /> .. ................. .... ' <br /> Zoning Admin" trator Konoo< <br /> d 0 00 0< <br /> NOTE: A preliminary site inspection most be nestle and site apl rd granted on Al structures involving sanitary f,\Cilve <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test-..lust b. attached , <br /> this implicatin t before a permit will be issued- Do not purchase or install a scpli,; tank, do any Plumbing ,, start any builJ <br /> ing until a permit has been issued. A permit may be revoked it roblePreSmala Cion of any of the information Cbuv, mI here <br /> with is found to exist. Changes in plans OF specifications shall not be made without approval of the Zoning Adminishatol <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />