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Burnett County - _ Office of Zoning Administrator V o <br /> r APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT - 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and recent <br /> shown herein. The undersigned agrees that al I work shall be done In accordance with the reouirnmants of the Be reg it Can my Lend Use m iU <br /> Ordinance, Sanitation Code,and with aalll�l other applicable County Ordinances and the lawn and regulations of the State of Wisconsin. <br /> ................................................................................ m o <br /> .. ....... n <br /> OW .JER(please print) / CONTTRR ACTOR or SURVEYOR or AGENT n <br /> . ...! y�3c�......7�7....._ s'v._L„L.lir:/CES....... . . - a .; <br /> DD�RE�S ADDRESS iQ <br /> ts.c:Y.......... .5Y7d� <br /> ADDRESS ADDRESS <br /> P ............................/..-.......... .PHONE.........................................._._.........._........_........._ .S.} i'c', <br /> .. ER WELL <br /> i:e a. .................... ..............................._.........._...................._......................... <br /> LUM Efl - WELL ORILLER..........._........................................ -- .v <br /> J <br /> /M�/ <br /> Fa..:. .c:. /O.f._.. .//... .......... . �... ......... . . . tl p <br /> ADDRESS_ ADDRESS _ k <br /> zx-...................................... <br /> 0 <br /> I PHONE PHONE Z � <br /> 0 <br /> DESCRIPTION 4. Sanitary Facilities: ° o 2 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms ....7% Ctq ca <br /> ca <br /> Addition ................. Septic Tank Size Gals. 70?:. <br /> Sanitary . .. Size .............. ft. x ..... ........ ft. .......... <br /> Filling .......... Height............. Stories............... 4a. Absorption Fie Site: <br /> Mavin9 .......... Arca .............. ................... Soil Type ......... ............ f, r i` <br /> Grading .......— Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .y a ' ;? <br /> Dr Well ..... <br /> Privy ........./ hi garage,motel,et 7c.�St_/> Seepage Trench <br /> Well l� .......... <br /> ... ..f//1.1.f..�L........:.:............. <br /> Subdivision PrivY — i !� <br /> ............ ....................................... - <br /> Seepage Bed /J-.X.J. <br /> Location of proposed structures and existing uructurio well,sewage systems, roads els.,should be sketched In Pap A. Include road <br /> setback, side and (rack yard dimension and location and setback from all bodies of water. If property is located d1 a highway inter <br /> section, show the intersecting highways and the setbacks renuired along them and at the intersection. CLEARLY LABEL EXISTING "a <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ----------------------------------------------------------------------- <br /> S. Lot Size: Fig. A. 6. Location: ? ^ r <br /> ....... ft. x ......... .... ft. — ._............................ IT.ft. .....................-............................................. .......... N. <br /> N o <br /> 0 <br /> - h <br /> w I <br /> w <br /> 0 <br /> as <br /> O � I <br /> as <br /> >v <br /> y tarda, Paz�� <br /> n ,aT. c � <br /> 7 to .fat 1, OMI <br /> a. <br /> -1°U of <br /> m <br /> r- 2— sr3 <br /> - ISignature oof n[ecr o7r-A-gen�ts —, tel Date <br /> Rem arks .U.�!7.,,,G[f,....Cz-z`-T.........._._.... .. . ...... . .. - M <br /> as <br /> v O <br /> 61. is <br /> ...: Gar ..........� ... �:f7._ ✓ �� .. <br /> ' . p.... ......... . <br /> o00ooron mInspection DateS .J... ..J.............................. <br /> . . 0000oZoning A'mm <br /> l <br /> o 0 0 0 0 o W <br /> NOTE: A preliminary site inspection must be nt'ede and site approval granted on all slruc lads involving sanitary facilities <br /> before construction can begin. In the case of sewerage dispas:d systems, a copy of the percolation lost must be attached to <br /> this application belore a permit will be issued. Do not purchase or install it septic tank, do env plwnhing or start any build- <br /> ing until a permit has been issued. A permit may he revoked it mi e.presmnzlion of any of the information conveyed herd <br /> - <br /> with is found to exist. Changes in plans or sp echicalion, shall not be ..lade without approval of the Zoning AdminisUaCu. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />