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cQ9?!E'll <br /> Burrett County Office ofZoning Administrator P <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT r <br /> TO THE ZONING ADMINISTRATOR: The underalgnetl hereby makes application[Of a Permit for the Work described and <br /> located as shown herein. The undersigned agrees that all work Shell he done in accordance with the requirements of IM <br /> Burnett County Land Use Ortlinance,SWtsllon Coda and with all oth7r applicable County Ordinances and the Tawe and <br /> regutat ions of l he State of Wisconsin, f—TU—f mrj. ll l't i✓I' <br /> r/ .............1° ...............:�J�.Q.! .�c. .............�P.A..9 &. .............. <br /> NER,�p�..Mimi QDNTRACTOR or 6VRVE'OR or AGENT <br /> .....f�TN�C �...._ ./V ..................... .................................................................... <br /> 4DORE55 ADDRESSS75-0 s �' <br /> ...................................... .�......................... ... ..................................................................................... <br /> ADDRESS ADDRESS !Do <br /> 6/z -3r..f�.:�`Fz/.............. ......................... a °y <br /> ......... .. .. . <br /> PHONEPHONE..................................................... ......................... ............................. 0 <br /> PLUMBER WELL DRILLER y J ;O <br /> ................................................................................. ............................................................................................ » Z, <br /> ADORER ADDPESS <br /> .................... . ...................................... <br /> ............................... .................................................. ................................ <br /> PHONE PHONE 2 S <br /> DESCRIPTION 4. SanitaryFacilities: ° B <br /> 1. Work: 2. Naw Building Details No.Bathroom) .......... <br /> New avlaliy T M at Connrue[lon: No.Bedrooms .......... „1 <br /> .......... <br /> Aeebwl „•,s,,iyP.d.}' ....,..-5/;. c�a. septic Tank Size Gals. ..Q <br /> .......... ��yyryv,� <br /> sr aurY tri Size..�8'... tt.x...Z 11. /.^.... <br /> I..... ...... <br /> .MQwl ag ......... <br /> u ,..o..a <br /> +foField S..i.t.e..: <br /> F011,1Dradnp 4s.Absorption <br /> .......... An .... ... Boil Type..................................................... <br /> MODiM slow .................. <br /> us Para Rate......................... .......... iR <br /> PrNy 3. MY <br /> fo %gersg , � Dry Wall ....... <br /> at Seepage Trench ......... o i <br /> Substrates .......... / Privy <br /> Damping unit . .... <br /> ..................... Seepage Bed [8r1. y C7 i J�, •` <br /> .g 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 also location and setback from all bodies of water. Ifpmpertyislocaledat ;� 3 <br /> a highway intersection,show the intersecting highways and the Setbacks rm fined along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 'lO <br /> -----------------------------�------___—_--_--__--_---__�______--__ <br /> S. Lot Size: Fig.A. 6. Location: }}v <br /> ................ It.x.............. 1[.- ............ sq.It. i <br /> !J� dLun K <br /> I 96r `.�VP,ft �. Zlrnmer <br /> Ltpland in, n1. <br /> Q _� py.cly Nap Ip— Grover MN 55-169 <br /> Sol <br /> 0 <br /> N � ry <br /> I T ' <br /> a <br /> 9 <br /> �1t i <br /> / Xpf$.�=ygssa <br /> 1J ZON � mOOO � <br /> ofn+ ma: 9 <br /> IT <br /> A: O <br /> 5 <br /> Signature of Oymor o Date <br /> Remarks. ........_.......................................................................................................................................................... a.. <br /> ............................................................................. <br /> ............................./........................................................................... .... ... . ;............. ....... <br /> Ins Sion Data... 2.....�...�......1. ..... ... .. _ .ry. e ' <br /> � Zoning Adminisint/r� .T17�/� g 8 <br /> NOTE:A preliminary elle inspection must be made and site ap val granted on all structures involving unitary facilities before construction <br /> can begin. In the cue of sewerage disposal systems,a copy of the percolation lest must be attached to this application 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 been issued. A permit may be <br /> revoked If misrepresentation of any of the information conveyed herewith Is found to exist. Changes in plana or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SMALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />