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Burnett County Office of Zoning Administrator L' -o0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 ?U' <br /> ...D ...A,.�Pusm Se l - o <br /> OWNER (please print) ,{ CONTRACTOR or SURVEYOR or AGENT <br /> ..... .� .. .1.. .CLW..I.[.U.YX.I.../.YV.�.:.................... ............................................................................................ <br /> ADD SS ADDRESS <br /> �, —c•�'C� <br /> i� <br /> s(�(yr . ..`Lel ' ...1...y..�..�.�.�':.�.:....... ....f�:�........ ............................................................................................ <br /> Z2E£S ADDRESS <br /> ............6.L2...'... Z`/.'.. .Ll./....................................... ............................................................................................ w i <br /> PHONE PHONE <br /> AN <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER 'X <br /> O <br /> ........................................................................................... . ......................................................................................... _. <br /> ADDRESS AD.. DRESS i m <br /> n o <br /> `r........................................................................................... . .............................................. ....................................... o' . <br /> PHONE PHON.... E Z H r <br /> DESCRIPTION 4. SanitaryFacilities: o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building No. Bedrooms ' 0 <br /> ...... Type of Constru�ttion: ......•.. T' <br /> Addition , „(ip�x,.,,,,,/�S?,✓c.�.......... .. Septic Tank Size Gals. .......... 9 g E <br /> Sanitary .......... Size ......V..... ft. x .... te.. ft. .......... <br /> a3 : i <br /> ' <br /> Rillingl Grading ,,.,.,,..• Height....7..... Stories .....1......... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... �� r <br /> Mobile Home .......... Slope .......................................... 7 ~ <br /> ............ y". . <br /> Privy .,,.,.,,,. 3. Use (describe exactly, 1 -family Pere. Rate ..................... kk ;V � <br /> Well ..•••••„• home,garage, motel, Is/c.) <br /> Dry Well <br /> ell .......... <br /> Subdivision .......... Seepage Trench .......... <br /> . IPrivy ..........Camping Unit .......... ... . ...... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Frt Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- O a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �<–, e <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. A o' <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: c <br /> 15..0..... ft. x 1.79.9... ft. — ...2.2.;;P .......... sq.ft. e).............. o <br /> :N N <br /> n <br /> N O <br /> o <br /> o x,` <br /> ` o <br /> J��cGf1� <br /> I/ T jay <br /> T <br /> SeetSR o <br /> jev <br /> •c. l � � tI�J•J m <br /> 6 o <br /> (�e <br /> I v {� � �Q a � m0 c m <br /> 5/ N <br /> Ul <br /> C< ,q . � m C <br /> t o S. m <br /> 0 5! <br /> �) m <br /> / / M <br /> /� .•:L - '-- ......6,1a6.1B6.......... o c <br /> Signature of Owner or(`Agent 1 Date 1_ Q ~ <br /> Remarks ......o-t..SL h'I:...i.tA.S .e�Lr�? ,...dfj/....: 4...e'..4.Hl.N.t....D�LS.l....�U.aS....repo' T .:................ x O <br /> J <br /> ��. . ...(n.b.�..fwit ... ... 7 ..v?`...cul. .-... ..4:oak..III:k ... ....re/v - el, <br /> ' <br /> VOrN t •K � !7C �a4U u✓ rC� o. �� �E... ..... <br /> . ....1...�...... 4'Y'�..°SJ�..............K...�(Q.........0.1!...�..........C...�.... .... Tim .. .'�..z..................)�Y?V... �� .0 <br /> Inspection Date ............. ......................... a �..... � ......`....-....�................. <br /> mm <br /> Zoning A istratorr <br /> 8 8 8 8 to <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> ,clica±ion before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> hermit has been issued. A permit may be revoker] if misrepresentation of any of the information conveyed here- <br /> ' to exist. Changes in plans or specifications shall not be marls without aoproval of the Zoning Administrator. <br /> YSTEM SHALL NOT BE CeVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> _�-,------+,_ <br />