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Burnett County Office of Zoning Administrator in o o <br /> '- <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 _ _o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and ocatexi as < — µ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Jse m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :/A <br /> a 1 <br /> kr. .] .o...A[........\!�L,.......SM. ..I.".."T...t .................. ........... .EL.�..................................................I...... ..... <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> ...J.p...� `� t ...IU:.... 3.ol....5r <br /> .. .. . . ........................... ...................................................................................... ..... <br /> ADDRESS o- <br /> ADDRESS <br /> .. .K. ....1—. M.a......�.!.N. l-..ssoy. ...................................................................................... . <br /> _ v <br /> ADDRESS ADDRESS <br /> ........................................................................................... ...................................................................................... ..... ' � <br /> ((fi�t 1 :o <br /> PHONE PHONE 'y./ <br /> 6 / A - 777 $7.30 <br /> ............... ..... ` <br /> PLUMBER WELL DRILLER <br /> .. . . .................................................................................. ..A..DD.....R...ESS.......................................................................... ..... <br /> ADDRESS <br /> n o <br /> G A <br /> ........................................................................................... ................................................... ................................. ..... .i <br /> PHONE PHONE � <br /> DESCRIPTION 4. SanitaryFacilities: 1 ° o <br /> h <br /> B <br /> 1. Work: Bathrooms i 2. New Building Details No. ••• •• ••' o <br /> New Building „�` Type of Construction: No. Bedrooms ... . ;,Q <br /> Addition Septic Tank Size Gals. ... ... J <br /> Sanitary Size ..o .Q..... ft. x .3-Z.. ft. """"' ^� <br /> Filling/Grading .......... Height S.F#TdW Stories /., ,.IP,�NR 4a. Absorption Field Site: <br /> Moving .......... Area niyo361.a. Soil Type ............................. ...... i .r <br /> Mobile Home .......... Slope ................................... ...... Ira .. <br /> Privy ........., 3. Use (describe exactly, 1 -family Pere. Rate ............................ ...... ,. <br /> Well .......... home,garage, motel, etc.) Dry Well ... ...... L <br /> Subdivision .......... ...F.9.M..1.L.}`........�....Q, �l...R, Seepage Trench ... ...... '. <br /> CamIn Unit p g i Privy ... ......� <br /> .......... ................................................ <br /> ------------------ --------------------- Seepage Bed------- — .-- f_ <br /> _ <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig. A. Include oad � 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 a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' <br /> --- ----------------- --------------------------------------------- 7J i <br /> 5. L t Size: - Fig. A. 6. Loc do <br /> ��ZZ �j �,/ __ �Jl <br /> . .Q..Q... ft. x ,+. a.. ft. — ...I.�-�.?.��'.�...... sq.ft. ..... � rl W.�..S............. ....... <br /> .. ....� .V.. ... ............ . S <br /> Q ° <br /> o � � <br /> I <br /> �t <br /> - E 0 <br /> p Rr yv <br /> Z 5 7 <br /> Nou 6 I T <br /> M Ql <br /> o <br /> w <br /> W Z <br /> w <br /> O N'r pft0 Rr� LINT' �a C : w Q f <br /> O In G w <br /> _ y n M <br /> � n _ <br /> rin <br /> �, c+�/ 2U±.. ,G�L ........ ...................................... ss c <br /> ... .... <br /> Signature of <br /> Owner o�r/A ent Date <br /> T : <br /> Remarks . .. . . . .. ........ . . .......... ..... ..... .................................................................................................. ... m„ � <br /> ..................... ................................................................................................................................... .... ` <br /> ..................................... ................................................................... .. ............. .. <br /> Inspection Date ..�..../`..:... ^'.......... . ............. o o r„ o rn <br /> . ..Zo.... gAdministrator �' 8 $ 8�8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures In olving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation est must be attached to <br /> this application before a permit will be issued. Do riot purchase or install a septic tank, do any plur Bing or start any build <br /> ing until a permit has been issued A permit may be revoked if misrepresentation of any of the inf rmation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of thi Zoning Adm inistratol <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />