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&;7-?C,&7�9 J) <br /> Burnett County Office of Zoning Administrator 0 0 <br /> 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 located as — 0 1� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> I-D.......L....... <br /> t3o .P.o. ................... . ........... P ►.E ........................................................ _ 0 1 <br /> OWNER�(/pJlease <br /> print) <br /> � Kn /�/�/' CONTRACTOR or SURVEYOR or AGENT <br /> AD TEz.!.�1...... <br /> T........ ........Y.�.....`� YA � <br /> ADDRESS <br /> Gv � S3....F ...... Ax ...... ..Y.... <br /> ADDRESS . .............. ... . .. . .. .. . .................. ...... .... . .... ..... . <br /> = I <br /> p , <br /> '7 p '7. . �7 <br /> P.f'. ./... <br /> —74.9.7 <br /> PHONE <br /> ................................................. .PHON.E................................................................................ <br /> PLUMBFR .W..EL.....L....DR...I..LLE......R..................................................................... ' <br /> ........................................................................................... AD � <br /> ADDRESS . .....DRESS..................................................................................... �m :i <br /> � <br /> ................................................................... 5y- <br /> PHONE ............. . .....................................-......... _. <br /> ............................................. o 0 <br /> PHONE ; --:. Z N <br /> DESCRIPTION Facilities: ° o 0 <br /> 1. Work: ' ' 01i v <br /> / 2. New Building Details o., athr0, �t� c <br /> New Building y �k Si ... <br /> Type of CP n's'1uction: - / <br /> Addition ,., .. ,,. .. ..,,..,., . �1�./��..... � SP9ti� ank Size Gals. � .......... <br /> G \ o <br /> n <br /> m <br /> Sanitary Size �b..... ft. x . .��... ft. r � <br /> Filling/Grading .......... Height............. Stories ............... tD <br /> tto Field Site: <br /> i <br /> Moving .......... Area ........................................... pe ................................... <br /> Mobile Home .......... �`, ..............................Privy .......... _43. ,Use (describe exactly, 1 family e ...................................well ........., home, arage, motel, etc.) ll .......... <br /> Subdivision ! �� Seepage Trench <br /> .......... .......... <br /> . <br /> Camping Unit ,,,,,,,,, Privy .......... <br /> Seepage Bed . <br /> ---------------------------------------------------------------------- I N rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig. A. Include road Q e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If . <br /> property is located at a highway inter- a <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXISTING I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> �py <br /> ...... sq. t. 6. Location: r. r..kv., f........ <br /> Gf/ � <br /> 5. Lolrt� Izg <br /> ...L�....... ft. x 3..0.x. ft. - .,�o�.Q:�.�.. 5q. ft. c...Lq ..'T.5'..QN... <br /> Oft <br /> 77 n <br /> 7 N <br /> o � <br /> q� 0 <br /> /V J <br /> LOT ZIN; <br /> d <br /> OC1n,� M VI r a y to Z <br /> Q ka <br /> (O Fl Q,, D O JJVV m c m c m <br /> Bolt (Jl < N C <br /> �S I LiaZ oo . Dam <br /> r V o �3 n b <br /> �o xyti o <br /> m <br /> Signatur) r Agen" t' Dat D _ <br /> �7' X 79 <br /> Remarks ................................................................ ..... ...................................................... m m <br /> 0 . <br /> ............................................................................ ..... _ <br /> .................................................................. g'X� <br /> .....................L...............?capproval <br /> ............. ... " <br /> Inspection Date ...................................... '�Q�lll.0 u u o 'o m <br /> ... . . ..........:... .........r. .... . . ...... r,t <br /> Zoning Admin is a r x"771 `-': 0 8 8 8 !/> <br /> NOTE: A preliminary site inspection must be made and s granted on all structures involving sanitary fac n a <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 herr <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />