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Pr:—PtzL11C <br /> ' Office of Zoning Administrator g,ATION FOR SANITARY —'LAND USE — BUILDING PERMIT d 3 <br /> >.\ ON ING ADMINISTRATOR: The undeP,ii,necl Labor makes appliwtlon :o a Permit for the work described and brand!as <br /> Ou Tres n. The undersia a dagrees <br /> with all all work Shall bedonein accordance t e l requirements of usfde.Burnett County Land Use p <br /> inai.ce, Sanitadon Code,and wIID all otbor oppllceble County ONinanecs and the laws and reguledons of the State of Wisconsin. 3 <br /> Ortl <br /> I <br /> t.?.Y.LP......./{.�o.P.o.�e.�4........,........ . ...................._._......................................................._._....... c d <br /> y <br /> O <br /> OWNER (plane print) -3.5-93 CONTRACTOR or SURVEYOR or AGENT S,^ <br /> 3137 NnY-tJel 14,11 Ir reniq-.✓T- <br /> —y <br /> .. ............................................................................... ............................................................................................ u <br /> ADDRESS ADDRESS pppm <br /> ADDRESS..... ................._..._............................................ .ADOR ESS........................................_................................... 6 <br /> 2C <br /> PHONE PHONE <br /> G.w �a.,/�oN .......... N <br /> PLUMBER s'y$O / WELL DRILLER <br /> r(..��....5:��. Tj........`5...C:°',;rva..::...!:':.'..x......._....... ... ..............................................._.................................. :"9 0 i <br /> ADDRESS ADDRESS :N <br /> o <br /> .. ...................... ................................................... . ............................................ ....................................... : o <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .....1.... 9.1 0 <br /> New Building ......... Type of Construction: No. Bedrooms <br /> Addition '� Septic Tank Size Gals. o <br /> Y <br /> Sanitt ._ Size _ ......... ..... ft. x ..IOX ft. ""'-'- V <br /> Filling .......... Height............. Stories ....).......... 4a. Absorption Field Site: <br /> 7s O <br /> Moving .......... AreaSoil Type ........... ........................ o <br /> g ......................_................. . slope .......T.P...�O <br /> Gradin .......... �. <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ..__!......... ............... .yL E i <br /> Privy .._...... home,garage, motel,etc) Dry Well .......... �1- i <br /> Well ........ .................................................... t� <br /> Subdivision Privy .......... <br /> Seepage Bed <br /> ____________ _ _ _ _____________ ____________ �` 'de l <br /> Location of proposed stn¢Nres and u1seling Structures well Sewage systems, roads otc,shoWd be sketched In Fig. A. Inclutle roar) <br /> setback, side and lack yard dimension and location and.seaaek from all bodies of water. If c <br /> Property is ABLY at LEXIS inter- <br /> slTRUC show the 'mtars OPO ED STRUCTURES <br /> and the setbacks required along them nntl at the intersection-CLEARLY LABEL EXISTING � I <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. V. ? I <br /> ________________ __________ __ ________________________________ _ <br /> 5. Lot Size: Fig, A. 6. Location: i �U <br /> ........ ft. x .... _. ft. - .._....._......._........ SR.ft. ....................................... .._........................... ...... <br /> . O i � <br /> v ro <br /> N 7 ff <br /> p \ 1 <br /> O 11 <br /> ^ 0 f <br /> O <br /> V <br /> Ti_ a' <br /> o � <br /> z .� IO n <br /> so <br /> \p^I <br /> i l�I <br /> M <br /> be W2I <br /> vcc<` f <br /> a do 2.Ci non <br /> z to F n <br /> o <br /> S . <br /> on <br /> /`�/ p r c - <br /> .... 1-ui(.rtadn ,5�� 'tea <br /> .. ........... .. G✓ .............................. ........ ............I .......... <br /> Signature of caner or Agent Date <br /> o it i <br /> ..... ............. x - <br /> JJ pp <br /> Remarks ....J.i':u../,1+/LOvt-�.:7F...�.�.�..(.F� T ^. � i r <br /> N <br /> .............................................................................................................. ....yp.....\/...Q......./..�......../................................... <br /> N <br /> W 'OI C/ Y"N t0rj� <br /> Inspection Date ........_..........................._ o Cl <br /> Z0 0 0 m l <br /> ........................................................................... . : t <br /> oning Administraro000boo <br /> r o 0 0 0 0 o t <br /> NOTE: A preliminary site inspection most be made and site approval granted on all stnmtdud' involving sanitary facilities-i <br /> before consbuclion can begin. In the case of sewerage disposal systems, a cupy of the percolation test most be attached 10 <br /> this application bnlnre a permit will he issued. Do not purchase or install a seutic tank, do any ilun ing or still 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 sbSll nul bn 111,111" without approval of the Zoning Atllninistrolol. <br /> _SEWER-SYSTEM-SHALL NOT BE COVERED UNTIL INSPI-CFED BY THIS OFFICE AND APPROVED' <br />