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./'7)['e7 7 "I' <br /> Burnett County Office of Zoning Administrator U0 noo 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3 o <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as H �• ;� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m '= <br /> Ordinance, Sanitation Code, and with all other applicable County Ordin nces and the laws and regulations of the State of Wisconsin. 3 a ?X5 <br /> O <br /> ....................... <br /> ... <br /> OWNER (please print) CONTRA TOR or SURVEYOR or AGENT o. <br /> `1 -v v <br /> ....................................... ............................................................................. N <br /> ADDRES� ` !S ADDRESS <br /> ADDRESS AD RESS : <br /> PHONE_ r�'P/r............................... PHONE V <br /> N L ISO <br /> VJ <br /> ................. .... .. ..... ............................................................................................ ; <br /> PLUMBER WELL DRILLER <br /> ........... ........................................................................ ............................................................................................ o <br /> ADDRESSQO ADDRESS '.x.r� 0 o <br /> ................. .G` .............(.j........................................... ............................................................................................ ` o <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. <br /> New BuildingNo. Bedrooms ..v-7.... ' <br /> .......... Type of Construction: :\ <br /> Addition a k Size Gals. ...... .. <br /> Sanitary .^..... Size L�.�ft. x .............. ft. ToL/ Hci� .......... <br /> FiliingtGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ................................... of Type ....................... . ....... <br /> 3 o <br /> Mobile Home <br /> Slope .......................................... e .. <br /> Perc. Rate ................................... <br /> Privy .......... 3. Use (describe exactly 1 -family <br /> Dry Well <br /> Well .......... home,garage, motel, etc. """"" .fir <br /> SubdivisionSeepage Trench .......... ? i <br /> .......... ............................I....................... <br /> Camping Unit Privy .......... w <br /> .'.. Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road o ;Q iT <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter- 0- <br /> ° :� <. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. -- <br /> __________________________________ —_____ —_--_--___ ° J <br /> 5. Lot Size: Fi9 A. 6. Location: .b (�t <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... ? `� <br /> 0 <br /> N o <br /> o J <br /> J <br /> T: <br /> J <br /> 0 <br /> F <br /> S <br /> 9 <br /> � :vv <br /> z <br /> � o <br /> d <br /> n d v d m z <br /> F <br /> O o < w <br /> ro <br /> Z O O a n Ml <br /> o J aro 3 <br /> o <br /> o <br /> oC <br /> Signature of Owner or Age i Date <br /> x : : . . . v <br /> Remarks .......f. .. .C . . `f !`-�."......... m <br /> .............� .. . .ZG.-tr "..�1.. :✓.GGZ�c..�J...6r.��c�-F�::GC-,:?-1 crY- ............................................................... `fl I n <br /> .....J/-; o - ................................................. . '.: `...... . .: ............................ <br /> Zonin A ministrator : 1 <br /> {fl Ur' r N Oc N <br /> tine. y� ov, ov, ov, r <br /> ....`ctlonDate ........................ g d kE <br /> F ' 888So' 8r/ <br /> ^, preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitieS <br /> struction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> 'ion before a permit will be issued. Do not purchase or Install a septic tank, do any plumbing or start any build <br /> ,mit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> STEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />