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eyJ?�4�? <br /> Burnett County Office of Zoning Administrator Iv c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws ind 3 <br /> regulationsof the State of Wi cousin. <br /> /U................................... ..... <br /> OWNER (plea»print) �� CONTRACTOR or SURVEYOR or AGENT ( <br /> .`/..... .:.....! .........5. ................................... .... ..-........! .Q..X....:51................................. ...... <br /> ADDRESS ADDRESS <br /> .......... ...... .....&EZ5T. Ek......-......IU.I ....................... ...... �tJ <br /> ADDRESS ADDRESS <br /> /. <br /> /...'.. !. ..-....`�.3�!-.1.3��/................................. .......5.!a.�?..-.. �..1............................................ <br /> PHONE PHONE <br /> X <br /> ........................................................................................... ..................................................................................... ...... <br /> PLUMBER WELL DRILLER <br /> O - <br /> ........................................................................................... .AD.......RES. 'E'S"S...................................................................... ...... <br /> ADDRESS Dn o <br /> < <br /> O <br /> .... <br /> ............... ........................................................................ .PHON.. ....E.. ..................... ... <br /> .......... .......................................... ...... .: <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bat rooms ... c <br /> New Building X. Type C�onstruetion: No. Bedr oms /... ...... R <br /> . . <br /> Addition ......._. ::!`;fn}!El,,,,,,,, ,,,, Septic Ta k Size Gals. ... ...... <br /> .......... q . j.......... <br /> Sanitary Size .:7..1.. .... ft. x ....,�.,Ki... ft. ... ...... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption ield S' e: <br /> Moving .......... Area ........................................... <br /> Soil Type ..... .. ................... ...... i r <br /> o <br /> Mobile Home .......... Slope .......... .. ..................... ...... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family PDerc. Rat ........ ................... ...... <br /> Dry ' <br /> Well home,qar{7]pe� tel,etc.) See age Trench o <br /> Subdivision ...........lJl...�.�1.. ... ...... <br /> .......... ................. <br /> Camping Unit ivy ... ...... <br /> .......... .................................................... <br /> Seepage Bed .. ....... <br /> -- — ---------------------------- — <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at _G _ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. v<—, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: :(') <br /> ............... sq.ft. ...... :.,G. <br /> J <br /> rao' <br /> o2. <br /> J <br /> � i <br /> Y, e <br /> 0 <br /> 0 <br /> f <br /> O T <br /> / m <br /> 0 <br /> O <br /> i 31 <br /> d <br /> J <br /> 1 ,Cfl13( N ` ,Dq <br /> m m r > m m -0 <br /> c N S_ S. m <br /> P� a n y'1vL way C <br /> o<. : d00 <br /> p41 K N prp ao <br /> S ;„o : " � > <br /> in <br /> 9 /U (� ............ e <br /> .......... ..... ................ ......... ..... ... .... ... . . ..1 _ <br /> _ C <br /> 9 <br /> m <br /> Si nature of wner or A ent Date <br /> Remarks <br /> m •• <br /> M N <br /> ..................................................................................................... ... O <br /> Inspection Date ....................................... . . a.r.ll /... ....:..... ..... a? ....X.!�...... .... �n v, �n o cn <br /> i Zoning Administrator', �'r✓1 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed ferewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND API ROVED. <br />