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Burnett County Office of Zoning Administrator I;' 'T o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2M J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 12 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regul ns of the State of Wis nsin. <br /> �?......N i�. ir��.... e. .......... �. .�f...... cci/ers........ .n� A `, <br /> ............ . <br /> OWNER (Please rind D pJ CONTRACTOR or SURVEYOR or AGE <br /> Ll%t....�J........Qu.a+.I......IC .4Lh........�J ..... ................... .�i ?. ....... .( .... ,..a .... ....... <br /> ADDR ADDRESS <br /> (t.........c...l.Q,r :.......... .�.....s1D� ADDRESS <br /> t....... <br /> .... . . .. ................................ ...... <br /> ADDRESS ADDRESS <br /> 7 - 1761 <br /> PHONE PHONE . <br /> :OIQ' <br /> .... ...... ............................................................................... .WEL.. ... ..... ..DRILLE.... .... R............................................................... ....... <br /> PLUMBER L <br /> O <br /> ADDRESS ADDRESSn C <br /> ....... ....... o <br /> ........................................................................................... . ........................—.............. ........................ w <br /> PHONE PHONE......... Z <br /> DESCRIPTION 4. SanitaryFacilities: 0 8 0 ` <br /> 1. Work: 2. New Building Details No. Bathrooms .. ....... <br /> New Building x... Type of Construction: No. Bedrooms .. ....... <br /> Addition .......... ....., ,�,o(Gj'/7},. �� /Q17/�epticTank Size Gals. .. ....... <br /> Sanitary .......... Size ..P7st....`. x ..cT.Q. ft. - .. ....... <br /> Filling/Grading y r 4a. Absorption Field Site: <br /> ........., Height.f7�.Q.�.. Stories ............... <br /> Moving .......... Area ..... Soil Type ....................78.. ..i ...................... <br /> Mobile Home Slope ................................ . <br /> - 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well Dry Well <br /> ,......... home,garage, motel,etc.) ""' — <br /> Subdivision Seepage Trench .......... i <br /> .......... ....................... <br /> .......... <br /> Privy <br /> S . <br /> Camping Unit .......... ...... .ra.. .�...................... . <br /> Seepage Bed ......— �. . <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. CQ c <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is Iota eclat i i L ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C : o--------------------------------------------------------------------- ' <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ...................................................................... ........ <br /> Q � <br /> N O <br /> O J <br /> J <br /> J _ <br /> b ( � <br /> � vV <br /> braco)nq <br /> t ( � <br /> T <br /> m <br /> Z <br /> O <br /> N <br /> J <br /> b <br /> m <br /> I <br /> D to co r- D lA a) -0 <br /> m c m m o c c <br /> o r^o' < J O m <br /> LD. Nn�< ' nm ani <br /> O m wo ] n <br /> Z^.o .z D ' 1 <br /> o NJ Na ' <br /> 8 n rn <br /> moo : m <br /> ...... ... . .... .... .......................... ........ <br /> S at of Owner or Agent Date <br /> O <br /> ema s m ' a <br /> u <br /> .................................... ...... ....... ... �........ ... ........ .................... ..... O O H <br /> �y//^n <br /> 7,an­t*,d'o"n' <br /> Inspection Date ....................................... Zoning AdministNOTE: A preliminary site inspection must be made and site a proval all structures involving sanitary f Icilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />