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Burnett county Office of Zoning Administr for <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ol the 4 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and dd <br /> regulations of the State of Wisconsin. 3' g <br /> 6. . .....Ch'.T... .G. ?.............................. .. :;..:7.. ?: ¢ n................................... . <br /> 07WYE (please print) CONTRACTOR or SURVEYOR or AGENT .4, <br /> IC....�.. -....... .......i.g. . .................................................................................... . <br /> b <br /> ADDRESS ADDRESS m <br /> 1 J J <br /> .5��..mil..... �4 ................................................ . . . . . ......................................................................... ....... — • . <br /> ADDRESS ADDRESS <br /> w!. . ........ .`I... ./........................................... .................................................................................... . :cam <br /> PHONE -PPrUVE' <br /> /lQ '.`....7.4....................................................... .................................................................................... ....... v� <br /> PLt'MBEft- Wr66 BRILLIE .� <br /> ........................................................................................... <br /> ADBHE6S —:.9e.�.�"a".r m 0 <br /> ........... ....... O .i <br /> PN9WG—. Z <br /> DESCRIPTION 4. nitary Facilities' ° o <br /> 1. Work: N Bathrooms 'O { <br /> 2. New Building Details •' •""" ey <br /> Now Building ... Type of C�nstructi n: No. edrooms .. ....... <br /> Addition ,,,,,,, FryDS- TI.,Fr„Q..„ Septi Tank S' a Gals. .... <br /> .. ... <br /> Sanitary .......... Si2e .. .. ....... . <br /> a:?!�.... ft. x .�.�.... ft. i <br /> Filling/Grading .......... Height............. Stories ,I 4a. Absorpti Field Site: i <br /> Moving .......... Area ........................................... Soil Type .. ......................... ....... '• : r <br /> Slope ° <br /> MobileHome .......... .. ....... ...................... ....... <br /> Privy .•........ 3. Use (describe exactly,'1 -family Perc. ate ....... ................... ....... <br /> Well ...,,,,.., home ara e, motel, etc.) Dry ell .... <br /> Subdivision .......... ........ ^ !.J.F^.:!XJ.4.a.................... Seg age Trench .. ....... i <br /> a .......... .. ....... <br /> .................................................... <br /> Camping UnitPr y <br /> Seepage Bed <br /> ---------------------------------------------------- <br /> cn <br /> Location of proposed structures and existing structures, well sewage systems, roads, etc. should be sketche� in Fi . A. : C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local ed at _ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. I 0 <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ___________________________________________________________________ _ i <br /> 5. LoF��� Fig. A. 6. Location: i..... <br /> ...1....1..1..!.. ft. x .............. ft. . ............................... sq. ft. ............................... .................................... ........ <br /> -� o 0 <br /> N 0 <br /> o <br /> o <br /> Z c� <br /> tv eN 1 i O <br /> sp � <br /> —EKO R-3 <br /> I <br /> ° <br /> m <br /> 'm m y rn r D w <br /> l a o< m C y > <br /> Om < N O M <br /> OZ fno 1�! D ' <br /> n <br /> o c ^ : RI <br /> 9 <br /> .. �� _ <br /> K n m <br /> SignatuAJ&,�'�r;�rlozrw�gent Date o <br /> T : N <br /> u <br /> o : <br /> o ' <br /> N m N N <br /> Inspection Date ....................................... ....1.�...�'�?r:u. .. .... !�...... .... <br /> Zoning Administra 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site appr I granted on all structures involving sanitary fa ilities before constructio <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 bee i 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 AP ROVED. <br />