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Burnett County Office of Zoning Administri for �' e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 6 1 a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the ,$ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulatio so the State of Wisconsin. 3. <br /> .... .. I 1�Lt L ; Ca l�fSiiAI g m <br /> . ....... . ...................................................... .................................................................................... ....... <br /> OWNER please print) CONTRACTOR or SURVEYOR or AGENT <br /> �/ JJ)/ /L7� <br /> .....................L...L.1f�.........✓.'•..�✓...........u. ,ef................. . .................................................................... ....... <br /> ADDRESS a <br /> ADDRESS Q, i� <br /> . . ................. ...U..� .................................................................................... ....... <br /> ...... .......... ................ i <br /> ADDRESS �. ADDRESS <br /> ...............................-.............................................. .................................................................................... ....... vr„�e�ry; <br /> PHONE PHONE <br /> .......igl............................................................................... . .............................................................. ....... ' <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS ADDRESS.................................................................... ....... <br /> m' r <br /> n 0 O <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms .. ....... -2 A <br /> Addition �/ Septic Tank Size Gals. .. ....... <br /> .......... -.SaniterY ze ...... . <br /> . x ....f:k. ft. .. ....... <br /> Filling/Grading Height....7.�... Stories ...I......... 4a. Absorption Field Site: <br /> .......... <br /> Moving .......... Area ......... 1:X...`.:......... Soil Type ............................ ....... c � <br /> Mobile Home .......... Slope .................................. ....... <br /> Prier .......... 3. Use (describe exactly,'1 -family Perc. Rate ........................... ....... <br /> d <br /> n ' <br /> Well .......... home,garage, motel, tc.) y <br /> Well <br /> Subdivision SCr�sc ��"<A� Seepage Trench onl <br /> i .. ....... V <br /> Camping Unit .......... Privy .. ....... <br /> .................................................... <br /> Seepage Bed .. ....... <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fill. A. c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersecl ion. `- <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ___________________________________________________________________ I ('t <br /> 5. Lot Size: <br /> 7 g. <br /> A. 6. Location: <br /> 2� X 1>3 •C rtl <br /> .....j.Q.O.. ft. x ............:. ft — ............................... Fi sq.ft. .....T.0... .....L:...........:G.L.L......✓.... .... i r <br /> 1 here F1 �i <br /> Gvc�1 LBr S See ?I � on <br /> j. <br /> 4 ' <br /> N <br /> vo <br /> e)e 12 ? u <br /> [rr r� ieyt� <br /> t2o � 51'vvrfu�e <br /> L T �{J <br /> Z <br /> O <br /> a <br /> �� ��PIOCj �L�Zs4F �4z/lS�!/ut �r <br /> p N D eR fr°� /wr�5 <br /> Z) fO V N r D W tP rn <br /> Tn E. E. RI <br /> o y^ro .`D0 >� 1 <br /> 10 <br /> Signature of Owner or Agent /� Daae,{- <br /> Remarks ... <br /> .......�.tS.M....V6.1..L/..LP . .c�..��....PlC�4'.5..!!!f�(.... '.'!!... !:�!....�dCW{C!t!... m n <br /> ...........�.N.......W�t...........`^'T(1�r.....FS.'CX7:@!Y:C. .LF/.:Q!�?)....... +.^......? �°X...1:4..�..... i`(r!�..�? .. .... <br /> U N : O <br /> ............. Ir.. -.......... :..c1`�b. ...l.R. .y'�. 5... �... .��.. ...�' . ..S' P�....... <br /> `':..... .... o s s <br /> NOD N T <br /> Inspection Date ....................................... .... ................. u, u, v, o o "'.n n1 <br /> ............... ....... ....................... <br /> ZoningAdministrator 8888 (A <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED. <br />