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n <br /> Burnett County Office of Zoning Adminis rator 0 --1 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L nd Use m e <br /> Ordinance., Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin � m <br /> a <br /> r: a <br /> m O <br /> ............. .. c.k....-.. ..........f r-.a x <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> a <br /> . s?lr......�1 .....�.................... . ................... ................................................................................. .......... a p <br /> ADDRESS .A..D...D..R..E..S..S <br /> ...VJa .0 ." Y. ...........Q.......... ......... <br /> ADDRESS ................................................................... .......... 1€ I <br /> f`� V <br /> ADDRESS <br /> .6.. ........411............................................... ..... . . . � <br /> ii <br /> PHONE <br /> . ............................................................................... PHONE K <br /> ................................................................................. .......... ]/may\v�' <br /> PLUMBER WELL DRILLER ;v a <br /> ADDRESS ADDRESS <br /> n o <br /> ........................................................................................... ............................................................................................ o' <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building No. Bedrooms a <br /> . ... Typ�of Construction: �"""�•' <br /> Addition Septic Tank Size Gals. .......... E ,� <br /> Sanitary .......... Size ...b2.. ft. x .....IZ. ft. " ..."" <br /> Ruling/Grading ........ Height........... Stories ............... 4a. Absorption Field Site: <br /> Soil Type ........... .......................I. <br /> Moving .......... Area�X.y`.,...r.�......... ... ........... . o <br /> Mobile Home .......... (l !�IV (�'"��F-4.J• , Slope ......................................... .^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate .................................. <br /> Welt ..,_.,.,,. home, garage, motel, etc.) Dry Well ......... <br /> Subdivision .......... G�Y..��� Seepage Trench Camping Unit .......... Privy ......... <br /> _______________________________________________ Seepage Bed________ ___ . <br /> Location of proposed structures and existing strucnires, well, sewage systems, roads, eta, should be sketched in FIg. A. Inclu e road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is cated at a hlghw y Inter- o. <br /> section, show the 'mtersectiny highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTINQ < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I p" <br /> ------------------------------------- -------------------------------.__ __-- <br /> 5. Lot Size: 30 acrPS Fig. A. 6. Location' ] <br /> ft. x ......._..... ft. - ............................... sq.ft. Q.a.�ai-,4....TowASAI i/.?J Lcci <br /> ....u.. <br /> Al <br /> wC <br /> N0 <br /> s To = <br /> 6 Ca, un r <br /> o <br /> 0 <br /> f3 <br /> < it p <br /> bas( <br /> Do <br /> v <br /> I v, <br /> P�Pa,-ty ;KQ X C r T *_ . <br /> of �N cr a < P f <br /> . u W <br /> m <br /> Z O O n <br /> oflae <br /> m <br /> FT <br /> FT <br /> t�G .:....7Z.9 .... l0./.6. g. .... IN s C <br /> nature of Owner or A en Date — <br /> Remarks .................................. ............................. ... . ...... ...._......... x rr <br /> � � .. .m� ................5. ............................... ........ rr <br /> . <br /> ......................................................................................................... .... ..................... .. ............. <br /> II <br /> nDn_' U tNl� O ImT0't") <br /> Inspection Date ....................................... WS.N,. ..Zoning Administ i tNOTE: A preliminary site Inspection must be made and s e approval granted on all structures Involving sanitary facilibefore construction can begin. In the case of sewerage disposal systems, a copy of the percolatio test must be attacher <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl nnbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the ir formation conveyer) here- <br /> with Is found to exist. Changes in plans or specifications shall not be made without approval of he Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />