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t 01 c3mpo <br /> Burnett County Office of Zoning Administrator IP e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and •Z i� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `a <br /> regulations of the State of Wisco sin. <br /> �..�.%.t`far� .Q....... ..... .a.a.'E:T ... ..............,S..r...1...1 ............................................. ..... c <br /> OWNER I le pri t) CONTRACTOR or SURVEYOR or AGENT <br /> .........AJl'....'E..ax....a./..f........................................ �.. ......................... <br /> a a <br /> ADDRESS ADD ... ... .................. .. .. ... » 1 C/' •• <br /> ADDRESS 5 �, ADDRESS <br /> . ............................................................. ............... .. .�..: ... ....�!�'. .. ...... <br /> SLJI <br /> PHONE ................................ PHO <br /> '� D <br /> ...................�..5.... ......�.�..... ................ . . ................ ...... <br /> PLU 9 R ` WELL DRILLER <br /> ,L` ~ ;r� <br /> d.A.. N..n.s............................................... ........................ .... . . . ...t ... moi. <br /> ADD ADDRESS �. ................ ...... i 'm .0 �. <br /> n o <br /> ........................................................................................... <br /> . ............................... ........................................... ...... O .i <br /> PHONE P..HO.. NE Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> / i v : L <br /> 1. Work: 2. New Building Details No. Bathrooms ... .. ... p c i� <br /> New Building X... TVe�of Construction: No. Bedrooms ... .. <br /> Addition 11.0 .12.,... /.L'/.. TUIL Septic Tank Size Gals. <br /> Sanitary ...X.... Size ... .4.. ft. xt ,-.. ft. ... ...... <br /> Filling/Grading ...... ... Height............. Stories ....1......... 4a. Absorption Field Site: <br /> Moving V Soil Type ............................. ...... r <br /> .......... Area ....7....2..��... 7."......... <br /> Mobile Home Slope o <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................ ...... <br /> Dry Well ... ...... m <br /> Well ,..' ,,. home,gdrage,motel, etc.) — <br /> �.....G L'....Fam.1..y Seepage Trench 0 W <br /> Subdivision .......... Privy ... ...... o <br /> Camping Unit ' <br /> A' <br /> `j.g�.Ni.�...................... _ <br /> ------------- --------- Seepage Bed--------- -- � <br /> --------------------------- — ,r <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. � ;^ <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at a U <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o ; !� <br /> -------------------------------------------------------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: ( � <br /> ................ ft. x .............. ft. . ............................... sq.ft. ....................................................................... .......59 <br /> ^. <br /> 174 o n <br /> j� y � <br /> � IU <br /> o <br /> f < f <br /> C <br /> T <br /> N C} <br /> O <br /> \V m <br /> �p <br /> 34 \. <br /> 'ri <br /> 77 fpr D Rica113 <br /> 0n ca s. =_. m <br /> 0 co <br /> om : �z " O <br /> o ro <br /> V Z_o m D 1 <br /> S hd n m <br /> � o <br /> 5- <br /> Signature f caner or Agent Date ' <br /> o : <br /> Rema <br /> ............ ................ ....... ............................................................ .... o <br /> /............ &3a...... gam. ° ... <br /> ....... ............................ <br /> Inspection Date .......� ���il../............... ....... .................. .. C!......... <br /> .. ...................... g o 0 <br /> oning Ad nistrotrator <br /> Gam `� 1 <br /> NOTE: A preliminary site inspection mustustbebe made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli oation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UN71L INSPECTED BY THIS OFFICE AND AP ROVED. <br />