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(_- -n C'e '1 - <br /> Burnett County Office of Zoning Administrator c - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <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 a � <br /> ............................... ....Ts'V. ,....P�c K ............................................... - 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 0 `_°. <br /> .T+4 .......R.4 T ��\ ) <br /> D[51. ................................................................................... <br /> ADDRESS ADDRESS » ' <br /> s4..09 3........... <br /> ADDRESS ADDRESS <br /> i <br /> !.!.5...-.CQ.35..- •4a3..................................... . .......................................................................................... <br /> PHONEI I ............................... PHONE k <br /> .. . ..1:-1.Q . ........... . .. . ....................................................................... <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ........................................................................................... ..A....DRES....'E'S"S................................................................... <br /> ADDRESS Dm 0 <br /> N_ <br /> ........................................................................................... ............................................................................................ O r <br /> PHONE PHONE ZH r <br /> DESCRIPTION 4. Sanitary Facilities: 0 o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••••• <br /> New Building Type of Construction: No. Bedrooms .......... y $ <br /> Addition .(.7!°f¢. E..s..ld.).GR.K...ra.k. E` Septic Tank Size Gals. ..... <br /> Sanitary .......... Size ...�4:.. ft. x ......z4: ft. <br /> FillingiGrading .......... Height....&...... Stories ..... ......... 4a. Absorption Field Site: i <br /> Moving .......... Area .......r—SLP....5.4.... 6:.:.... Soil Type .................................... F� o <br /> Mobile Home .......... Slope .......................................... <br /> i <br /> Privy ,,........ 3. Use (describe exactlyPere. Rate ..................................., 1 -family Dr Well .......... 9� <br /> Well .....,.... home,garage, motel, etc.) y I I <br /> Subdivision „•,•,,,,• ( �-t� Seepage Trench .......... <br /> .... I?QQ.....li , .r1. 77?+�....... <br /> Camping Unit .......... Privy <br /> .......... i <br /> .... P..cRAr.4 . ......................... Seepage Bed <br /> ------------------------------------------------- — — <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- I o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O <br /> s <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (✓U 0' <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: -FtVf✓ Fig. A. 6. Location: <br /> . -. r?... ft. x ...`,?.Q.U. ft. — ........ sq.ft. ............................................................................... <br /> 11 e <br /> or, <br /> I M t l E Q RST 1 o <br /> 764L-mocis At Ii.14, <br /> �o2T A 51 o'13 F=P t I�R-o Pe>sE-D o <br /> 0 <br /> ._ <br /> F <br /> ovep– loo' �f�M ' rttH1 <br /> A ly Lar >_ ,v4e <br /> Z <br /> a i� <br /> G.TN st o rr M to r v v, m <br /> IM O E <br /> d d m <br /> D o1 < C <br /> Z o p m D <br /> ' o of �a m <br /> . .4 .....1. ...�........f $... ....... o - <br /> Signature of Owner or gent Date ° — <br /> X <br /> m <br /> Remarks ......................................................................................................................................................................... m: 0 <br /> en <br /> ........................................................................................................................................................................................ 31 n <br /> ............................................................................................................. ..�.w..1........... . ................................................... :v� : <br /> Inspection Date ....................................... �z { ......... ........... . : Idi �,r r"'n o �n o m <br /> Zoning dministrator 8 8 8 8 8 8 y <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />