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CJyJ�y- <br /> Burnett County Office of Zoning Administrator W lao 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3 0 � <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as m <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 and the laws and regulations of the State of Wisconsin. 3 o\ <br /> ^' a <br /> ,r N ° <br /> .o..n.a.. ..> ............. .Q...:.s.'..?... ........................ .....................................1/................................................. _ <br /> OWNER (please print) , . CONTRACTOR or SURVEYOR or AGENT m <br /> ......AJ....Ii..........0-1.1/..S.V,I,.C.�............................... ............................................................................................ d ' <br /> ADDRESS nn ADDRESS <br /> w prl k� h Mlh /l. . .. . s S <br /> ADDRESS ADDRESS -k 9 0 <br /> ....J..l....... .�.R..!A. .n..s................................................ . . ....................................................................................... <br /> PHONE PHONE <br /> ;r0 <br /> .N <br /> ........ ..... ....... <br /> ................................................................................... ............................................................................. <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS Esti n o <br /> G :_! <br /> ............................................................................ ... ..................................................................................... <br /> PHONE PHON.... E <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> Bathrooms <br /> ....�.... � ^., <br /> 1. Work: 2. New Building Details No. Batro ' <br /> New Building No. Bedrooms <br /> ,,,,�, Type of struction: "'� � <br /> Addition „ ,,,,,,,,, hQ —t <br /> Septic Tank Size Gals. <br /> �.................... P J J < <br /> Sanitary ... .. Size .....C .�.. ft. x ....J�... :-ft. 7S.9c� <br /> Fillingl Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ......................... Soil Type .................................... r i <br /> .. ............... o <br /> Mobile Home . .... Slope .......................................... "�9 <br /> �5 <br /> Pere. Rate ................................... •. .S <br /> Privy ... 3. Use (describe exact) 1 -family O <br /> ....... <br /> Well ... home,garage, motel, Dry Well .......... t_v d <br /> Seepage Trench .......... <br /> Subdivision .......... <br /> Camping Unit ....... Privy .......... l <br /> ... ........................................ ........... PP E 9 <br /> Seepage Bed <br /> — /o. y !_ <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If 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 H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �e\O <br /> ------- -------------------9—— — <br /> — ———— <br /> 5. Lot Size: Fi A. 6. Location: ya <br /> ................ ft. x ............., ft. — ............................... sq. ft. ............................................................................... <br /> 3 0 <br /> o <br /> N o <br /> O <br /> � :Q3 <br /> o v <br /> 0 <br /> e <br /> �o <br /> t <br /> T <br /> O <br /> m <br /> m <br /> 9 C W <br /> m <br /> � �aa < = '_ grey <br /> m <br /> Z O O n <br /> za n <br /> Vr o <br /> f 0 <br /> q m <br /> ..... .............. ................ .... .............................. ...................................... 1 0 C <br /> Signature of neeir r en Date . X .: .: <br /> Remarks � �/ Z . m <br /> .. . ............ ... ...... ....................................................................................................................... — <br /> 0 <br /> m . <br /> r i . . . . .::... lG ..... �-.. - _ <br /> .......... ...... . ... . ... . .. ........ .�./° . ..... .......... .... .............. .... 11 [ [ f <br /> Inspection Date ..l.. .�.. .Q... .C...-��. %! .� 9 .-........................ Fn <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 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 />