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-C�'-J ✓ 9 . <br /> Burnett Counfy Office of Zoning Administrator0 0 <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 and located as < rn o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances/s and the laws and regulations of the State of Wisconsin. <br /> 3 <br /> `Da <br /> ....... .,/.Il..�. ......>..r/. /.. .1..� _ ........J....... .... / :> <br /> .................................. m O <br /> OWNER (please rintf CO CTOR or SURVEYOR or AGENT m <br /> .. . . . .. ........... a <br /> ............ <br /> 2 i x <br /> ADDRESS ADDRESS <br /> � :... .. . /.U:......5'S.-1�......... .....'« ....../� s.<....L... V <br /> ADDRESS 'ADDRESS <br /> ........................................................................................... ...... .5. ....... 4a......................................... <br /> PHONE PHONE Tv 111-t <br /> .. . /.. -..7....7...�/�.do...�..... 5........ ............................................................................................ <br /> PLUMBER WELL DRILLER" ° t: <br /> ........................................................................................... ...................... <br /> ...................................................................... <br /> ADDRESS ADDRESS i 0 <br /> o <br /> <' <br /> ...................................................................... .PHONE........................................................................................... <br /> .......... p <br /> PHONE <br /> .. ........ <br /> Z �^ r <br /> DESCRIPTION 4. Sanitary Facilities: - ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .... .... <br /> U <br /> ' <br /> 3 ;-f• � <br /> New Building J( Type of Construction: No. Bedrooms L�Qiv <br /> Addition .._......_ Cl/(.,�„� { ;-1�I ,. Septic Tank Size Gals. .......... p <br /> Sanitary ...... Size 43..l ... ft. x 2.4.. ft. .......... <br /> PIIIIngf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o r <br /> Mobile Home .......... Slope ........................... .............. ° <br /> Privy ,,........ 3. Use (describe exact) -family Perc. Rate ................................. . <br /> Wall „...,,,,, home,garage, motel, a c. Dry Well .......... M V ; <br /> Subdivision ,,,,,,,, - � Seepage Trench <br /> a <br /> .. ,ra.z.x......4..,7.':............... ...... 4k <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> .......... N <br /> Location of proposed structures and existing structures well,sewage systems, roads,etc., should be sketched in Fig. A. Include road t ° <br /> setback, side and back yard dimension and location and setback from all bodies of water. IfA' <br /> property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING W < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a o' <br /> _—__ ______ --------------------------------- <br /> 5. Lot Size: Fig' A. 6. Location: e'' <br /> llBG.l,� <br /> s:N <br /> e <br /> O n <br /> m <br /> N <br /> t <br /> � 0 <br /> O <br /> F <br /> I <br /> s <br /> i a <br /> In :moo <br /> A- <br /> z <br /> Wr� ° <br /> V y , l� <br /> _ M N rn; F 0 in Z <br /> n cr < m ctE <br /> m <br /> a (n <. w m c m <br /> m <br /> Z oo Da70 <br /> o n m <br /> .. <br /> p <br /> r... <br /> �.. Y....... lD• .......1..:..:..7...:��� � <br /> rr er or A ent Date <br /> X 7g <br /> Remarks „Y ....... m <br /> ................./..lam. ....zz/-Z,..G.�:.........-A5 . .�`.... 1...��L ci............. ././....-..... ............................ — <br /> II <br /> ........................................................................................................... . �............... <br /> �J <br /> ;C : t1T <br /> Inspection Date . ..'.'.Cf....`..A... ...... /... v!-`.r!..(....:...... .:..: j... 'fit?v.............. t9 p N �(?I ' 8 m <br /> Zoning Administ FJ . . 8 e8 en <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />