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r <br /> Burnett County Office of Zoning Administrator ;+ d M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 » VJ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use '� m m <br /> /J/�!/ C. <br /> laws and regulations of the State of Wisconsin. p 3 a :� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the <br /> zld <br /> Z)6< , <br /> / �e di T i ....J.'U*' .PucT/a/ii 2 N M .� o <br /> �F.L�6 <br /> OWNER (please punt) CONTRACTOR,pr SURV EVOR or AGENT n' a <br /> ............... <br /> ADORESS <br /> ............ <br /> ....... <br /> ............. <br /> —............. <br /> ............................ <br /> .ADDRESS.......... ............................................... £ <br /> G3'E�STFP Y✓� s�s/e�93 5i�E�/, zN! 5�7� A _ <br /> ............... <br /> .. .. ........... ......................................................... .. .................................................... <br /> ADDRESS ADDRESS <br /> ..�e'9-X55'/..................................................... <br /> PHONE PHONE <br /> M: i <br /> ........................................................................................... WEL. . . ..L DLL.....RIL'l'...ER..................................................................... � :_N- <br /> PLUMBER <br /> 3i in <br /> ADDRESS............................................................................ .ADORESS.......... <br /> ................ <br /> ...... <br /> ............................. <br /> ................ Z <br /> Z, o <br /> »............. . . . .................................................................... ............................................................................................ o <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .... o o k} <br /> New Building T of Construction: No. Bedrooms ALL*.— 3 (� <br /> Addition — P�.PCY/ ,,,�',,, mq•F.QAM•..=••• 6.�C'//,,,,,, Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ....O2v. .. ft. x .....��:.... t. .......... y < <br /> Fining/Grading ...,...... Height..,O.�.. Stories ..2.N...... 4a. Absorption Field Site: <br /> Movie Area B� tl9P Soil Type ............../•U•. .......... i :� IrV <br /> 9 .......... ......... ........... ............. <br /> Mobile Home ,,,,,,,,,, <br /> Slope ..................../� :........... � <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .............. .. ........... .. ti <br /> Well .......... homey garage motel motel etc.) Dry Well ... <br /> .... �.GE....... � renchSubdivision .......... ............ Seepage ...... <br /> Camping Unit .......... ..... ........ ..... Privy <br /> .................................................... H <br /> i <br /> Seepage Bed ......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> (� a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> U <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o O <br /> 5. Lot Size: 3 // JJ (`/ Fig. A. 6. Location: t <br /> ..1f.3.... ft. x ..�.....1?. ft. — .. �.Xl...l7....... sq.ft. ............................................................................... <br /> /jio R7fI SAAlol A/lG /a s 1 <br /> a - <br /> 1 ` N O <br /> 0 O <br /> � o <br /> O :N <br /> 3`3 <br /> 0 <br /> 30x3 ° €5� <br /> 7 <br /> loo f�j M rn m -o W M Z <br /> c m < m c m <br /> IQ n < n F <br /> ASA d �Cd �o /2a o �, m y a m <br /> oZ o o Q � <br /> AAIMEn 3 <br /> pg. c m <br /> ........................................................................... ................... ............... <br /> .... o : C <br /> Signature I. Owner or Agent _ Date <br /> x — <br /> ��CN TU QE Awl-7, ®,U /o/a Of- z:)eIS71w,6T f C 4i EoaFt /f m <br /> ................................................................................ .. <br /> Remarks .. m <br /> yekk sHo�° 4i/f/cH /5 if4Q69py ��� of BUFF S/ 'uc/��t Wit _ <br /> .............................. ........................................................................................................................................................... <br /> ......:...... . ................. ..... . .......................................... I . . . T <br /> Inspection Date ....................................... <br /> .. . ...... " m <br /> ..... .................. <br /> pZoning Ad istrator $ $ $ 8 8 tm/� <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 he 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 Iie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />