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Burnett County Office of Zoning Administrator d= � 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. _ N-� <br /> o :\ <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m '^ <br /> m ax <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 <br /> .�.I.b .r. ....�...r.a.1 .e ............................ ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> ..... ...l.l a 1...1�1�....... .m.�.... n �C <br /> AD RESS ADDRESS <br /> ia.$ . . .�j..s..,..CYI..�.n.n. ....�.5.0.3. .... ............................................................................................ <br /> ADDRESS — C ADDRESS XJ /1 b <br /> PHONE PHONE <br /> :(0 <br /> ........ . .. . ....................................................................... <br /> . <br /> PLUMBER WE....LL DRILLER U i <br /> O <br /> .......... <br /> ........................................................................................... .................................................................................. _. <br /> ADDRESS ADDRESS n o <br /> .............. O <br /> 0 < <br /> ........................................................................................... 'P'HON. 'O"'N.E.................................................................... ri 5 <br /> PHONEZ = <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... �" <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> ........tic Tank Size Gals. ° D <br /> Addition .. .................................................... Sepr ; � <br /> Sanitary - ".. Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: \� i <br /> Moving .......... Area Soil Type .................................... C! <br /> Mobile Home . . ...... Slope .......................................... 0 <br /> o <br /> . . Fare. Rate ................................... C i <br /> Privy .......... 3. Use (describe exactly, 1 family p <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... .p i <br /> Camping Unit ........................—... Privy .......... Vy <br /> ������ ...................... Seepage Bed .......... k.. <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched In Fig, A. Include road 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- ty d <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTINGiat <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS e o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: UU /� Fig. A. 6. Locatio <br /> ....�.c .�..a.. ft. x . ...1 ft. — .1D.1,+-�.. 5.0,.D.D sq.ft. .....L<.i;..11L'....R+�.� <br /> Ju5� 5outlt a oliY\30 <br /> LgKe- Sev\) ice VCA O3s <br /> _ <br /> 9> <br /> Application for land use Camping Permit from May 17 , 1985 to o U) <br /> November 17 , 1985 . <br /> T <br /> O <br /> #�( n93 qn � ���fiem - -- pre ollo ly <br /> "IlIrv\,s � ��-t�d and cc �prou�ecL <br /> — <br /> N m 4 m <br /> ,qC ,� roc � <br /> CD y n <br /> m <br /> Z oo ng70 <br /> �o JJ <br /> Signature of O r or Agent Date . . . <br /> / x : : : m <br /> Remarks /�!�:.'""' (y�(� m <br /> M m <br /> .............................................................................I........................ <br /> ........................ .. <br /> a: T <br /> Inspection Date ....................................... .. 1�..''.'.u.'.' .. .............�'"X..w'.'.�....... m <br /> ....... ..... <br /> . 0: N N 8 m 8 N m <br /> N N O T O 4 <br /> Zoning Admin strator T✓ 8 8 8 8 8 8 rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> before 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 /> 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />