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rpt 2;;7 <br /> Burnett County Office of Zoning Administratord 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use A 0, <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n ' <br /> Ro — <br /> .[.1...... " 0 <br /> y 5.�1 F n <br /> ...........:....... <br /> N <br /> O/�WNE (please print) CONTRACTOR or SU RVEVOR or AGENT m <br /> �i're.....1... .o..7�L.C1. :: ..... a <br /> ............................................................................................ a <br /> ADDRESS ADDRESS � � �`�� <br /> I,v E,b S 7--kl- .....�.1 o...:....:-��/�i` � <br /> .............. ............................................................................................ <br /> ADDRESS ADDRESS ' <br /> PHONE .......................................................... PHONE .................................................................... <br /> /VotN ... . . . . . t <br /> PLUMBER WELL DRILLER <br /> p <br /> ADDRESS ADDRESS n o <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building •• „ Ty e of on ryy{{cttlon: No. Bedrooms .......... 1 - <br /> Addition � /Ci`1'Yr1 Septic Tank Size Gals. .......... <br /> ... kG...................................... <br /> Sanitary ...••..... <br /> .:........ Size .. ..Q..... ft. x ...�.�.. ft. <br /> Filling/Grading g 4a. Absorption Field Site: <br /> . ........ Hei ht. ........ Stories ............. . i <br /> Moving .......... Area .9100.. � Soil Type .................................... <br /> ......................... r i Mobile Home .......... Slope .......................................... o 0 <br /> Privy „........ 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... <br /> Well .......... h me,garage, motel, etc.) Dry Well .......... ' <br /> Subdivision r Seepage Trench <br /> ..��1. �}° ./I�Q.��'1 � See a e .......... � • l� <br /> Camping Unit ,,,,,,,,,, Privy .......... <br /> .................................................... Seepage Bed <br /> .......... I✓' <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road tMa <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- CL <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ° 1 <t. � ➢ <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �qp { / / _ u;-' <br /> --10.7... ft. x .v7Fl f. ft ....�0 0.14 7. . s ft. l0'1 E?N.....^.A, K—....../v.......1c <br /> d�acru. ---�--0.I <br /> 5. Lot Size: i Fig. A. 6. Loi ' i L <br /> ,,yy�q� c �I I N <br /> N VO�w c taax z 00 <br /> 0 <br /> T E � <br /> O <br /> . "� �rcPpSti� �. <br /> et o.�Ar�r� � T :o <br /> N <br /> Vt uU <br /> €v, <br /> � � SCrsarJ ' arc-h <br /> Nr' ? :E' m Z <br /> O� O o fA cr ” 2 f <br /> < <br /> 2. <br /> 01 <. w : e m '13Q� f" Z $ o � D o m <br /> ve <br /> � � a <br /> ............ ..... u.................... ...... .... m <br /> Signatur of Owner or Agentf Date � �X <br /> Remarks .. ./�!v!ri <br /> AAI ;:5 1.�l/S!��'e. ......�L ?.QY...�Q//�Jc .. !`.........�...�Z.Q....r............... T, <br /> .............................................................................................................. ................ <br /> S <br /> Inspection Date m <br /> . . .. .............. o 0Zoniministrator $ 8 $ $ $ y <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 not 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 />