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Burnett County Office of Zoning Adminis rator � o 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 <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 Wis onsin_ 3 iDo_ <br /> 4111 L L/ y <br /> /�M /VA�YKA SfFME SFS OW <br /> ................................................................... ... ................... ......................................................... ....................... ..... <br /> OWNER (please print^) A ,I �! Q CONTRACTOR or SURVEYOR or, AGENT <br /> ..¢SO.S Off•K GT�/UE.......^D. . . . . . ................................................................................. a � <br /> .. . .............................. ............... <br /> ADDRESS ADDRESS as <br /> .............................. <br /> M ........ <br /> . ..... <br /> TF ss�a a� <br /> ADDRESS . ................... . ............................................................................ <br /> ADDRESS <br /> .. ........................................................................................ ` <br /> "'Ni PHONE................................................................................ <br /> PHONE <br /> "'Ni :\I <br /> ld - 454 -S8b7 <br /> LLER <br /> I <br /> PLUMBER . ............................................................................... .......... <br /> WELL DR <br /> ADDRESS .ADD....RESS.. .................................................................................... <br /> 0 <br /> n o <br /> PHONE ..........E.................................................................................. � ., <br /> PHONZ N <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: ° 0 ° <br /> i. Work: 2. New Building Details No. Bathrooms <br /> New Building ,,,,, Type of Construction: No. Bedrooms .......... 0 11' <br /> Addition .. ... .................................................... Septic Tank Size Gals. .......... UVJ i <br /> Sanitary ......, Size ft. x ft. .....•.... <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area Soil Type ......................... .......... r <br /> Mobile Home ........................................... Slope ............................... <br /> .......... O <br /> Privy ........., 3. Use (describe exactly, 1 -family <br /> Rare. Rate ........................ .......... <br /> Well .......... rTe, arige, motel, etc.) Dry Well .......... i <br /> Subdivision �( -lj�/T(nti/ Seepage Trench .......... <br /> Camping Unit .......... GLOBE Privy .......... <br /> Seepage Bed <br /> ---4alN iii':..N.................... ...... <br /> .......... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc_, should be sketched in FIg. A. Inclu e road qo <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- 1 on <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXI 3TING w <br /> 1� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> ---------------------------------------------------------- __-- i <br /> 5. Lot Size: ,/4q A G Fig. A. 6. Location: <br /> ..1l7.S ft. x 431..4. ft. — .rS��.b..IO g. ft. Gou'T.. .�.T. .....SE4Tl.4M..�8,... .¢oN € <br /> ...... <br /> Tawny 0FSGo7-7 0 N <br /> S//EE Co�Y SURVEY ATTAGJ{Ep I <br /> / 3 O <br /> A DO <br /> 1< µ 1 <br /> 0 <br /> r T <br /> 3g l <br /> EXIS7/N6 <br /> 6A6114 <br /> M 0 r no rn z <br /> n Q < c m <br /> LD satsato a`< — —' n <br /> F <br /> on <' C cm <br /> � m _. m <br /> t o 20 : a a 77 <br /> y ro �,K E <br /> /o/Z4A i'°° 1711 <br /> f!fl.�LY✓!.. . ................. ................ ...................................... �o p <br /> Signature of Owner or Agent Date t, _ <br /> 'v/I X . . . . . .Remarks M <br /> S1 <br /> � O <br /> ................................................................................................................................................................................. ...... <br /> Inspection Date ....................................... .... .. ...... ../. .....y�. ..... U o N m <br /> m <br /> Z Ing Administrator 0 0 0 0 0 to <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures it volviny sanitary facllitlus <br /> before construction can begin. In the case of sewerage disposal systems, it 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 here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval oft e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />