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Urnett Co:inty Office of Zoning Administrator f Z <br /> - APPLIC.ATION. FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> O THE 70NING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> :^.,vn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use mom. <br /> 'd'nance. Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. '\ <br /> `- 3. <br /> :Y r.. . ...( ;1.%..� K..ti.. ........................ ....................... ..�..F ............................................ <br /> 'w:aER (please P, ntl CONTRACTOR or SURVEYOR or AGENT 0 o <br /> � ...... .... ............................ ....................... .......... . ........... . ............................... a <br /> UDRESS ADDRESS <br /> c <br /> ............ <br /> ........................................................................................ ................................................................................ <br /> .DDftESS ADDRESS <br /> .1. :..-..x. ..6.....$6S... .................................... ............................................................................................ <br /> HONE PHONE <br /> ............... <br /> ......................................................................................... .. ........DR................................................................. <br /> LUMBER WELL.. ILLER <br /> D <br /> _................................._.._................................................. ..... . .........................................................................,. n C <br /> .CJDRE SS <br /> ADDRESS ` 0 <br /> o <br /> ......................................................................................... ............................................................................................ ,» := <br /> HONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ' .0 o ° <br /> v <br /> i. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Bultdmij ,. ,,, Type of Construction: No. Bedrooms .....I.... ;p <br /> Addition �r°--�•-2 Septic Tank Size Gals. ... ..... ; <br /> L l <br /> Sanitary Size ..2::/..... ft. x .... fI. <br /> .�.. <br /> Filling/Grading ...... ... Haight............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .....L.61:.l.£,...f.4_1c4......... Soil Type .................................... ; r <br /> Mobile Home .......... <br /> Slope .......................................... <br /> Privy ...,.,,.,, 3. Use (describe exactl 1 -famiiy Perc. Rate ................................... lr i <br /> Ory Well .......... :h <br /> Well .......... home,garage, motel, et <br /> Subdivision Seepage Trench <br /> ,,,,,,, '. <br /> ,,, <br /> Camping Unit .......... ..........................................I....I.... Privy .......... T <br /> Seepage Bed .......... <br /> .--- ------ -- - — ---- ------------ ---- ----- ---- N <br /> "cation of proposed strucWres and e. sling structures, welt, sewage systems roads etc. �houltl Uo sketched in F Ig. A- Iry ludo ru J Q <br /> etback sde and back yard dimenso and location and setback from all bodies of water. It property is located at a highway uiva �- <br /> �.,:;ion, snow the Int"cling highways and the setbacks required along them and at the incl Accbon. CLEARLY LABEL EXISTING `- <br /> T iIUCTURES AND PROPOSGD STRUCTURES AND ADDITIONS. o <br /> -------- ----- <br /> ----------------------------------- - ------ ' L. <br /> 5. L t Slze: Fig. A. 6. Location: n <br /> .. ....... ft. xt.............. ft. - ............................... sq. ft. ............................................................................... ; <br /> n_ <br /> q O J <br /> � L <br /> `O --I <br /> `� -- --- -�� f <br /> 3� <br /> 0 <br /> 75t 0 <br /> 0 <br /> f <br /> " <br /> � c a <br /> ry N Q C - d Q �, <br /> ��fe- u , r s 4�•� fw� s� few ( I Fed/tics 7t e D ° e <br /> � m <br /> .0 oo a <br /> e.K /Slr'l 5b 5y'Yi✓l 7 r v� L�l� t^' u�'i <br /> \\o <br /> �............. ....... .................... `o - <br /> S�ynature f Ow r Agent Date / <br /> fiCmarks ...........��/.-�...../`5. Gl ..N..C'_`.?:!..6/.4.v:�G(.�^. ......fir, �11.C(!br ....v1 ........0?KlSil..i.C�:.................... x <br /> Y7l N V� S 5 t/ c i ........ir)S V� <br /> �i.... r <br /> r. ....................................................................... .. ................. <br /> Inspection Date ....................................... <br /> Zoning Admirs9trator « 8 818;8!88 <br /> - <br /> NOTE A preliminary site insr pection must be made and site approval granted on all SIIUCutres involving sanitary fdCll to <br /> ,•fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation trr1 must be attacher) I•, <br /> this application before a permit will be issued. Do not purchase or install a septic lank, do any plurnrtel or stop any Inulol <br /> ny until a permit has been issued. A permit may be revoked if misrepresentation of any of till. rnfurnnition conveyed hey, <br /> -vith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adrnmislreto, . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />