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Burnett County Office of Zoning Administrator d 7 o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H o _ <br /> 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use -oi <br /> c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a <br /> C;harIles.V bar+ Schmidi �t¢11.... N f <br /> .............................. . ................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m - i <br /> 4% ,Ill Goent SA, 'Il Box 11 552- <br /> a <br /> . ............................................................................ . . ...... . ............................................................................... a <br /> ADDRESS ADDRESS m i <br /> Etlswnrtll 1.1i 5401 ► _ <br /> ADDRESS ADDRESS <br /> -11V2-13-3163. <br /> ..................................................... 7d <br /> .. . . <br /> PHONE PHONE <br /> ...........�.No Se. ..................................................... [ T <br /> PLUMBER . ................................................................................. <br /> WELL DRILLER <br /> yn. <br /> ........................................................................................... ..... .... r <br /> ADDRESS ADDRESS .. ................................................................. � m Ll !'{• <br /> n o <br /> ........................................................................................... . ........................................................................ ... <br /> . .............. o ,» <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details 0 <br /> New BuildingNo. Bedrooms <br /> Type of Construction: <br /> Addition „ ,,,,,,,,,,,,,,,,,,, Septic Tank Size Gals. <br /> ......................... .. . <br /> Sanitary .......... Size .............. ft. x ............,. ft. No SEWER Rt• 'PRl � E <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: ilic <br /> i <br /> Moving ✓. Area ........................................... Soil Type .................................... i :,.I <br /> Mobile HomeSlo e .......................................... :O o <br /> .......... p <br /> .......... 3. Use (describe exactly, 1 -family <br /> Privy Pairs. Rate .........................:......... o <br /> Well ....... home EDmotel, et,0 Dry Well ? 6 <br /> Subdivision Seepage Trench .......... <br /> .............................y.............. Privy <br /> Camping Unit .......... ,.14.x ilr M¢bur I1..(t1¢J� <br /> 111 11 .............. <br /> xe al Seepage Bed <br /> ----------------------------------9------------------------------------ N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be. sketched in Fig. A. Include road [� <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 = <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _______________________ fr1 <br /> C> <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ....... ft. x I.11.O...... ft. - ............................... sq. ft. .......... <br /> 1J a <br /> S p a d <br /> qj <br /> O ~ <br /> O <br /> 7 <br /> to s 7 1 SO <br /> 3° ' S,oq” i 9P s9� e. <br /> IL 71 <br /> >itgd_, 6 <br /> of 14 xaa O�1 1 d ST z Z <br /> t aJarCall <br /> 1 �',• �d � o <br /> 1" •V priveWA To'Al <br /> U ai fi <br /> f„r �6 Qub1�S' Y <br /> LLLnd¢.t.Ae pee <br /> v d accesslot Ill" • <br /> S a.s,e.,cL bdp+w i� <br /> 7J ad r 9 N W <br /> `D <br /> to <br /> Cal <br /> s: - : ems m <br /> zC:) n <br /> o ] n o 31 <br /> Z' <br /> 01 - <br /> bi <br /> C1�owQ¢a... . n: 3u1 \9,1g91w.......... a p <br /> ................... ... . ....... ..-.... .................. o C <br /> a. <br /> Signature of Owner or Agent Date _ <br /> 1 X JJ <br /> Remarks ......................................................................................................................................................................... T Ino <br /> m <br /> ............................................................................................................ <br /> Inspection Date ....................................... ..... ...... ....iCy .......... .... 1 u o o m <br /> Zoning Adminis or q o 0 0 0 $ g Vs <br /> O <br /> NOTE: A preliminary site inspection must be mad nd 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 ne made without approval of the Zoning Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />