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Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT NO 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and •20 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A c ) <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 `g <br /> regulations of the State of Wisconsin. <br /> a <br /> X...Lar. � iti:.�............i5.44R.Rl..S........................ ............ .F..................................................... ...... A r� <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 40 <br /> .. ..................................................................................... . <br /> ADDRESS ADDRESS <br /> ,5.:,3"11..9...... ............................................. <br /> ADDRESS/ /7 L�` �J Q ADDRESS <br /> PHONE PHONE.. ../ ,/... ...(...Y...//.......................... .PHONE ..... <br /> .. . ...... ............................................................................... .W.EL. ..L...D...RILL......ER................................................................ ...... <br /> PLUMBER <br /> O <br /> ADDRESSADDRESS ^ C <br /> .......................................... ...... <br /> .. . . ............ ...... . . ... . ...................................................... .......................................... . <br /> PHONE PHONE o N o >� <br /> DESCRIPTION 4. Sanitary Facilitie c <br /> v r <br /> 1. Work: 2. New Building Details No. Bathrooms .. ....... o New Building , Type o No. Bedroo <br /> nstru tion: " """' <br /> Septic T ySizeals.Addition � .............�.�................................Sanitary Size .............. ft. x .............. ft.Filling/Grading .......... Height............. Stories ............... 4a. Absorption ite: <br /> Maving .......... Area Soil TYpe ... ............... ....... r <br /> ......................................... - <br /> .. Slope .... .............I........... ....... i » <br /> Mobile Home .......... "' - <br /> Privy 3. Use (describe exactly,'1 -family Perc. Ra ........................... ....... i <br /> .......... '1 <br /> Well ........., home,garage, motel,etc.) Dry W m <br /> �I See ge Trench o `• <br /> Subdivision .......... .....�/.�*N............. .................... Pr. y <br /> Camping Unit 7•,•, <br /> .......... .................................................... p g <br /> See a e Bed .. ....... D <br /> --------------------------------------------------- <br /> Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fi . A. 1 <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locald at p L <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> _________________________________________________ -- i <br /> 5. Lot Size: ` Fig. A. 6. Location: <br /> ....�,.3�... ft. x ..%l..... ft. . ................ sq.ft. .Z,z?Sr..Imk.�(...... T...1fJ��..V...�Qf^• ........ :� E <br /> C?n �' O <br /> UA I✓UrJ �C N o. <br /> O 7 <br /> I <br /> � F <br /> kkj Lek OUei �(Uor_S pts T a� <br /> T'JA <br /> M i p <br /> O �. <br /> p <br /> a <br /> m <br /> Lf <br /> 0 Nv < > > n C. C= <br /> m a� amaam <br /> ��pp o m 0 f0 f0 <br /> ` tlN�vdgS Lp�y o iA0 D -4 <br /> NO ya � <br /> o a : <br /> c m0 <br /> � m 0 <br /> y. _ <br /> I <br /> � .. . L:a::z� z.............. ... ......2..7.........`x. A, : <br /> m <br /> G o o <br /> Signage of Owner or gent Date o <br /> N <br /> Remarks ................................................ <br /> 5�� C . r... . ...........�.... <br /> . ... y...P............................Z...�.�../... <br /> � ... ... ... <br /> ... 5. ...... ..... . ......�... . .�..�......................... .... .... <br /> Tmm <br /> DY, <br /> ' <br /> fT <br /> < >}^ c o . <br /> S.: vmn m <br /> Inspection Date ...........................4........... .. ...... ......�:... �l u, v, u, o m <br /> Zoning •••••Inistrator•• •• 8 8 8 ca <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f ilities before constru i <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app ication before a permi will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee i 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 ANDA PROVED. <br />