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1 <br /> Burnett County Office of Zoning Administrator 0 o <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 �7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m i9J <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a o �J\ <br /> O <br />....Tom..Finn.................................................................... ............................................................................................ o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENTn. 1.6 <br /> m < <br />....Granksl?ur.8.>...W1.....54.B.0....................................... ............................................................................................ d rD y <br /> ADDRESS ADDRESS ^ .3 <br /> ........................................................................................... .A..DD.....R" <br /> .... .............................................................................. 'x] <br /> ADDRESS S <br /> ....7.15,..4.63-5332........................................................... .Pl�oluE........................................................................... <br /> ..... [ a <br /> PHONE <br /> rta�d..Daniels...................................................... <br /> PLUM � <br /> PLUMBER WELL DRILLER <br /> v <br /> ...Box..k1..S.iren,...W.i.....54$7.2.................................... ............................................................................................ _. <br /> ADDRESS ADDRESS n o <br /> .....7.7.5-.4.63..-2333........................................................... �. <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> Ii1. Work: 2. New Building Details No. Bathrooms .......... :� o <br /> No. Bedrooms 2 niC 'oma <br /> New Building ......X. Type of Construction: .... \ <br /> Addition <br /> .;gtRgtgjXip:ay..A.®me,..frame Septic Tank Size Gals. ....Q0.0 9�y < <br /> •......... <br /> Sanitary ......,7L. Size ......26.... ft. x .....44..... ft. .......... <br /> ' <br /> Rillingt Grading ,,........ Height............. Stories4a. Absorption Field Site: <br /> ............... i <br /> Type .. .. . <br /> Moving .......... Area .......S4/.k..e$ Soil Tt...,ft............. yp .......................... .... . <br /> o i <br /> Mobile Home .......... Slope .......................................... <br /> Privy ..,....... 3. Use (describe exactly, 1 -family Pere. Rate ......$............................. C' E <br /> Well .......X. home,garage, motel, etc.) Dry Well .......... a, iv <br /> Subdivision .......... „•,,,,,, Seepage Trench .......... ''� <br /> ..s17C1B1.2...f.dWk.1.Y..... .hom.e1 <br /> Camping UnitPrivy .......... <br /> .......... .. ...........................I..................... <br /> Seepage Bed a Mound .......... N <br /> _____________________________________________ 1 <br /> U0 ac) <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- o- <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. V o” <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: it. I i <br /> �3� <br /> .......�.0q.. it. x .'..I.62.t.�9t. — ............................... sq. ft. ............................................................................... w <br /> :I � <br /> m <br /> K <br /> N �O <br /> O r D <br /> d :N <br /> O�1 <br /> t � <br /> T W <br /> PP <br /> o✓ Z <br /> m <br /> m <br /> n Q om_ o ED�E a VI G C00n 0 _ <br /> Hi <br /> \0 <br /> m <br /> ... ......................... ...................................... C <br /> ......................... <br /> Signature of Owner or Agent ' Date <br /> Y m <br /> Remarks ......................................................................................................................................................................... m : <br /> v <br /> ............................................................................. .... . . . . . ................. ................................................ <br /> Inspection Date ....................................... :�/.724'�. ...... . ..................... 1s: <br /> m <br /> Zoning Adm'fistrator m <br /> K/ 8 8 8 8 8 8 y <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 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 />