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cyl�G-c14'9L�-9 <br /> Burnett County Office of Zoning Administrator Q - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H G ?V <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 Count Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> PP Y 9 <br /> ic/ � /�RuivDt,E = d o <br /> ....................................................................... ..... . . ........................................................................ <br /> CONTRACTOR or or AGENT <br /> �44R. <br /> �4Y. <br /> OWNER (please print) SURVEYOR a <br /> oo�� ,n <br /> .. ...e.& -.4-4.4....... ................................................ ...... .......... a �� <br /> ADDRESS <br /> ADDRESS � <br /> _ <br /> ADDRESS ADDRESS <br /> �� <br /> ............................................................... ............................................................................................ <br /> PHONE PHONE <br /> /VdNUO��............................................. . . ................................................................... <br /> PLUMBERWELL DRILLER <br /> :o <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS m <br /> n 0 O <br /> ........................................................................................... ............................................................................................ p ,.i <br /> PHONE PHONE Z n — <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 E\ <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building ...,,,..., Type of Construction: No. Bedrooms .......... z <br /> Addition Septic Tank Size Gals. <br /> ...X.... ....................... . ................. <br /> Sanitary .......... Size ....7�-0... ft. x •......•• <br /> FillinglGrading ,,,,,,,,,, Height. //.?y 4a. Absorption Field Site: <br /> ls� / Stories ...1........ . <br /> SoilType .................................... <br /> Moving .......... Area .......................................... YP r <br /> Mobile Home Slope o <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ......4............................ ~ <br /> Well .......... home, arage, otel, etc.) Dry Well ........ <br /> Subdivision ,......... Seepage Trench .......... <br /> ...... . ......... ../104 '`.1...... <br /> Camping Unit .......... 7�. ... .... Privy .......... <br /> ............ .... .�6.. . <br /> _acsZoG�L�iu�Co Seepage Bed . <br /> Location of proposed structures and existing strut res, ll, sewage systems, roads, etc., should be sketched in Fig. A. Include road •O <br /> -------------- --------------- <br /> setback, side and back yard dimension and location and setback from all bodies of water. if property is located at a highway inter Qja <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------------------------------------------------------- 0 <br /> 3 <br /> 5. Lot Size: /�a• �— Fig. A. 6. Location: <br /> .110..d.... ft. x .Yl......�ft. . ............................... sq. ft. ............................................................................... <br /> e <br /> m <br /> �N O <br /> O 3 <br /> 7 0- <br /> IA) <br /> N <br /> / D <br /> 0 CAS 2 Jecv � <br /> s <br /> �m :w <br /> l I� � ° <br /> RM <br /> hp / / � <br /> �0T fort 4`7y <br /> � �h�J C <br /> "O (Nl1 < m d L M <br /> e m <br /> p m D p m <br /> n <br /> i� I+ 4o kb 'oma <br /> .. .......................... .............. ...... .............. o 0 <br /> Signature f Owner or Agent /a e <br /> X <br /> Remarks ........:................................................................................................................................................................ m m <br /> v <br /> • II <br /> c : <br /> Inspection Date G( �`y//� :./. ..... . ` Ifi' ru m ro m <br /> ....................................... . ... ......... . ...?L/ o rn o rn o rn <br /> Zonin Ad istrator �� J o N <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 he attached to <br /> this application before a permit will be issued. Do riot 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 />