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c� � � r e71- \. <br /> Burnett County Office of Zoning Administrator d o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT M, 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as "'� ~ 0 :?S <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 oa i� Vt <br /> m (� O <br /> cll............................ .............................. ............................................................ � 1� <br /> O/WJY ER (please print) 'T1 CONTRACTOR or S RVEYOR or AGENT a <br /> /Lr ./ ...1..1... ate" <br /> ............................... ............................................................ d <br /> ADDRESS <br /> r-7� ! , A } ADDRESS m <br /> A�(GSZ/a.......... /..5 ........ 116, . ..... .ADDRESS............. ............................................................. i\ <br /> . .9..-.Z.1..4..a............................................ ........................... ................................................................ <br /> PHONE "A........................................................ PHONE ............................................................. :Ss <br /> PLUMBER WELL DRILLER <br /> i <br /> ........................................................................................... ............................. ............................................................. <br /> 17) <br /> ADDRESS ADDRESS <br /> 0 o <br /> .......4l. ................................................................................ . . . . ................................................................................... O <br /> PHONE PHONE Z 'Qs <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o <br /> New BuildingTyp f Constr ction: No. Bedrooms <br /> Addition ... ..... <br /> �n Septic Tank Size Gals. ' <br /> .....�1I,A. I.�(�..........'. h .... .... < � ~ , <br /> Sanitary Size ...q•/• y. ft. x ..�.Q.... ft. <br /> Filling/Grading Height....Z...... Stories ............... 4a. Absorption Field Site: �U(' <br /> Moving Soil Type ......... . .................. <br /> .... ..... Area ...................... . ............... r <br /> o <br /> Mobile Home .. Slope ................... ...................... !1v N <br /> .... ... <br /> Perc. Rate ............ .................... <br /> Privy .... ..... 3. Use (describe exactly, 1 -family N <br /> O <br /> Well 1home garage, motel, etc.) Dry Well ... .... b ;r, <br /> Subdivision ,,, Seepage Trench ... ..... <br /> c........................ <br /> Camping Unit J;,,, Privy .... ..... a: i <br /> ..... .................................................. <br /> Seepage Bed ... <br /> . ..... y <br /> ---------------------------------------------------------------------- C .N <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road v Lai <br /> 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-r� 1 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `V 1. �1 N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. '\ o <br /> ---------------------------------------------------------------------- <br /> 5. Loot Size: Fig. A. 6. Location: i <br /> .J..�.Q... ft. x .2.l ft. — ............................... sq.ft. cn C <br /> nI `mac' p <br /> � r)o <br /> QeNA2AC— <br /> f <br /> ` : o <br /> I cc r < m m Z <br /> s <br /> IN� t\1 o 01 ' m <br /> rn <br /> Z O o D n <br /> 3 <br /> 1 l loe Y'2l''I^n� <br /> I � — sRtir �f—s e�77�.�. �• v, <br /> ppe -c- mp-46e. ee c <br /> beer• tz.-� Q,n,...s to !-k •rr' bio _ � <br /> ............................. .... 9, <br /> .............................. �9Z3 quo <br /> Ignat OOw r I Date <br /> [9J� or Agent � t]��..........9..-1./..-. .......c. x' .-x ....... : v <br /> Remarks .......Y...N/Q........ .....C-"�..r4� ... <br /> ..........r ......T.s 0117a......,a..y...... ,s �...�1/ �7, .v���...��� ./...�.x....... � _ <br /> .4... ../.: � ��.�c........�.�1. ..-.Z . .... ....................... I 'I <br /> Inspection Date ....................................... ... .........9.... ................:..................... 1^ : : : 8 <br /> T <br /> Uo o rn <br /> Zonin A ministrator 8 8 8 8 8 <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />