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Burnett County Office of Zoning Administri for <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3• 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� Lf <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> Maxine Mashek - A <br /> ......................................................................... ..... .............. . K. ...S. ..... . . �.......... ...... _ <br /> OWNER (Please print) TRA TO or SUR EV o A T p <br /> Rt. 1 — <br /> .. ........ . ..' . <br /> 0 <br /> ADDRESS ADDRE io <br /> ID <br /> Siren, WI 54872Danbu ,y W, 54830............... iX <br /> ADDRESS ADDRESS ....... ................. ...... v .f, <br /> PHONE........... 1--r15,656-3......................... .......... ............... .PHO .... .. .... �.. . ......... ...... :N <br /> Donald Daniels /.......................... I :m <br /> PLUMBER WELL DRILLER ;� O <br /> Box..............Siren,...WL.... ........................... g o <br /> ..................... .... .............. <br /> ADDRESS ADDRESS -- � � m .G1 <br /> r .�. ... <br /> o <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. SanitaryFacilities: °_ o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details i0 0 1 <br /> New BuildingNo. Bedrooms ...... ; <br /> ....x.... Type of Construction: `'C' R 'tVI <br /> Septic Tank Size Gals. :� 0... ' <br /> Addition .......... .........F.P-4 -.> ...................... .. .J .c <br /> Sanitary X,,,, Size .a�C7...... ft. x a�c�..... ft. .. . .... <br /> Filling/Grading „ ,,,,,,,, Height............. Stories ..�........... 4a. Absorption Field Site: i <br /> MovingSoil Type ............................ ....... :r• r- <br /> .......... Area ...........b.UO......................... na o i <br /> Mobile HomeSlope .................................. ....... :£ » <br /> .......... <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ........................... ....... iN <br /> Well .......... home,garage <br /> oteletc.) <br /> ......... <br /> Dry Well .. ....... m <br /> ., <br /> Subdivision ,.,,,,,,,, `/,GIe4”" Seepage Trench 0 <br /> Camping Unit .......... ................... Privy .. ....... <br /> .................................................... .p <br /> i <br /> CT . <br /> Seepage BediX... ' - <br /> .. . :m in <br /> ----------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fill. A. <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at ,C :p g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. Y� `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' i To <br /> c o <br /> 5. Lot Size: Fig. A. 6. Location: :w '�' <br /> 3 i <br /> ................ ft. x .............. ft. - ............................... sq.ft. ....................................................................... ....... <br /> - - -Ctaffk o f Y4 G m (, 91 <br /> m 'V� <br /> NN o. o <br /> 0- o <br /> 10� o sC N <br /> - e7 <br /> g o <br /> f �+ caPh See <br /> Z <br /> ,7100 <br /> M fAM0r- DIP Co <br /> n � 5- S o �� E. M <br /> nny <br /> v < d C y > > 3 <br /> 8N N O 0 m <br /> OlRO � � D 1 <br /> rn� ya ' <br /> _ a : y <br /> n o p <br /> N..0.......... l..G./..�..iU.Q....,.O.............L...t..]^Q'�..i7.... .........e.....G.. �(J�dT/dO+�y�- �.3 �ih7/�. <br /> .........C. o...pl... . <br /> .. <br /> ;.: <br /> o <br /> M <br /> .......... .............e ....... <br /> Signature of Owner Agentpat <br /> Remarks ...... ... /"✓( CS .TG ..... .. ................. <br /> ...................... S <br /> ......................... .................................................... �a d ...................... . $ <br /> Inspection Date ....................................... m <br /> M <br /> ZoningAdmini ator '�'M 8 8 0 0 0 8 0 <br /> i <br /> NOTE: A preliminary site inspection must be 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 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 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 UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />