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f l '-0 <br /> Burnett County Office of Zoning Administrator be -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '< — <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 a 1N <br /> LA <br /> / 5 a <br /> '!.1.1.�G...^� .. ..kc.n.c.�.................................................. .......�ct,�c',&� JF........................................................... � � 6r = <br /> OWNER (please pi,WW CONTRACTOR or SURVEYOR or AGENT 0 <br /> ......a... .l..y.....:3.ii..... �......................... ......J2.T..1. ...................................................... <br /> ADDRESS ADDRESS '�' <br /> I m _ <br /> JV1..t.n.�..�: ./tc./.t.5........m.inn............................... .... .n. t.rx.:'.:Sbu.... ..� :.5. <br /> ADDRESS ADDRESS .......................................... 1 :, <br /> 'L6.5... .M................................................................ <br /> PHONE PHONE <br /> B L D <br /> ............................................................................ WELD" h�E`RI'L''L"E'R.................................................................... ; 5 <br /> PLUMBER <br /> ........................................................................................... ............................................................................................ : .O <br /> ADDRESS ADDRESS <br /> n O <br /> ............ <br /> ........................................................................................... ................................................................................ <br /> PHONE PHONE Z <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: a ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building 1, No. Bedrooms ....;:k 'oo <br /> zl Type of Construction: n <br /> Addition Septic Tank Size Gals. ....... <br /> Sanitary X... Size ....�.�...... ft. x ..St'?...... ft. ...••....• <br /> Filling/Grading ,,,,,`,,, Height....1....... Stories ....I.......... 4a. Absorption Field Site: <br /> Moving .......... Area .....l.60f�.� Soil Type .................................... o <br /> . ;10.................. Sloe .. <br /> Mobile Home P .......................................... <br /> Privy ........ 3. Use (describe exactly, i -family Perc. Rate ................................... L� <br /> Well .,.,�,., home,garagg, mo el, etc.) Dry Well .......... <br /> Subdivision /.....� Seepage Trench .......... J <br /> Camping Unit .......... .....................)............................... Privy ll' W <br /> Seepage Bed .......... �T+' <br /> ___________________________________________________ _______________.___ L •G to <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be, sketched In Fig. A. Include road I t c: <br /> setback, side and back yard dimension and location and setback from all bodies of water. If <br /> properly is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -----------------------_------------___._—_-------------__—__----------- .d <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq. ft. ............................ v m' <br /> ............................... ................................................... X, o <br /> x rn. <br /> t�SA`,�k � � G o 0 <br /> � � w <br /> �m <br /> ,,,, 11of <br /> .IS�jun1v ' n Voia I a <br /> �P ^ ir".. o <br /> \/ at' <br /> CIS <br /> F <br /> M co M :E RI Z <br /> d <br /> BE town m o a F <br /> L �` a s: . y a m <br /> mm ` � <br /> VI r ie J . /Azge�n <br /> ignature of Owner ot � Date VJ�J <br /> Remarks .,+�74H�rEr�...0 ��,.. ..ks.... ........V..j...4?....9f?r:?. -c33...GE. ............................................................. x <br /> .............................................................................................................................................................................. <br /> � = <br /> !� rl <br /> N @'l <br /> NInspection Date ....................................... ... .. ..... : ................:..... u,Zoning A inistrator : i 8 ooNOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f 'es <br /> Fyefo,re 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 /> - <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 tie made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />