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.nett County Office of Zoning Administrator -4 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulationsof the State of Wisconsin. <br /> /2 � I SI� <br /> .......................... .. . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> aBF?....!� ...!qve....................................... ..................................................................................... ...... <br /> ADDRESSADDRESS <br /> s�../ ................................... <br /> ADDRESS ADDRESS i <br /> I <br /> PHONE PHONE --�� <br /> .. . ...... ............................................................................... .WE. .L..L DR...R— 'L...ER....................................................................... <br /> PLUMBER ILL � <br /> ADDRESS ADDRESS 0 ;a <br /> PHONE PHONE Z H 0 <br /> DESCRIPTION 4. San ary Facilities: ° c ° <br /> 1. Work: 2. New BuildingDetails No. Ba rooms .. ....... c <br /> No. Bedro <br /> New Building ,,,,,,.--- Type of Cons ruction: <br /> Addition fjQ/gry„� Septic Tan 'ze Gals. .. ....... <br /> ... '�y .. <br /> Sanitary .......... $i2e .., .....ft. x ..w7T.. ... ft. .. ....... . <br /> FIIIInglGrading ght.. .......... Sto ' s ... ........... 4a. Ab rpt' n Field ' e: <br /> .......... Height 11F' / <br /> Moving .......... Area .. ... `-'f. Soil ype ............................ ....... r <br /> ..... ......................... o <br /> Mobile Home SIC ........ . ...................... ....... .. <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rte .. ........................ ....... <br /> Dry Well P <br /> Well .......... home,garage, motel,etc.) " """' — <br /> subdtvielon 416, .r�fR Seepage ch .. ....... o N i <br /> Camping Unit .......... .................................................... Privy ....... _— <br /> Seepa Bed ..... . <br /> ------------------------------------------------------ ____________ __ N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., s ould be sketched in Fi . A. :X- �c <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is Iota ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. il/ o 15 <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :UI <br /> 5. Lot Size: Fig. A. 6. Location: r � C <br /> dlO..... ft. x ../.9L...... ft. . ............................... sq. ft. ....m?... $fnld....!�AI('G ......................... ........ <br /> N <br /> � o <br /> i f <br /> s <br /> serf 4iNe / OeC1" 24-irf Z <br /> �- 99ft �� t�eoposed Exis-kiN7 <br /> 24o <br /> d <br /> 27' O $fP�IL wvwrnmw� <br /> A, �crc '— nm nag <br /> � (Q <br /> //SOLI,�.•� Z ON �G � fO <br /> GSPa�i 1'� m <br /> v : o <br /> S <br /> g�rpf s7 X p, o <br /> ........ ............................. ................. ................ .. . ......... ... <br /> Signature of Owner or Agent Date $ <br /> Remarks ............. .......... T <br /> U.... j (.�1 ...j ....... ...1...:C.��......, ............................................................ ...... <br /> V ........................................ ......... .............I..... <br /> /��/ � T <br /> Inspection Date ....................................... :/..%.�... .. .. .7,rt!(!...1 �: N g J m <br /> m <br /> Zoning Admin rator o g N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before constructio <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans ol specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. , <br />