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Burnett County Office of Zoning Administrator &n 00 <br /> 'APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 D :� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� µ .� <br /> u <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n y <br /> 1VAR. .71v...... Zif/ N.S./.1,./.. .oR.�.i►i..... T�.....�EL�rvt�i:........., � a Oo <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> ...� . ....................... .......................................................... .......... <br /> A DRESS ADDRESS <br /> 1i Oe b474de...........W# <br /> .........y .7............. {�E..b f��P........... ..r.....,�'Y. T......:....... <br /> ADDRESS ADDRESS ?. <br /> .....drlE ..-.....7...vi?3'r......................................... ....... <br /> PHONE PHONE <br /> R- A._6&v.kllf...... ........................ Z,.....Zh47A%ISIOO c........ ....... <br /> PLUMBER WELL DRILLER , <br /> ADDRESS ADDRESS p'..p gJ V <br /> ................................................... .... ° <br /> . . . .................... .PHONE PHONE <br /> N <br /> DESCRIPTION4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> .... <br /> o <br /> New Building ,,,✓.. Type of Construction: No. Bedrooms .... •'Z a E <br /> Addition .,.. Septic Tank Size Gals. ...... <br /> ... .. 3 °q <br /> Sanitary ...�... Size ..6.Q...... ft. x ...o2.y.... ft. .�;••••••• <br /> Filling/Grading ......6... Height.,Q0. .... Stories ....... 4a. Absorption Field Site: <br /> Moving ......... Area oil Type ...........6... <br /> ............ <br /> Mobile Home Slope .... ... ..... ........ ;............. A 0 <br /> .......... <br /> 4 <br /> Privy .....,.,,, 3. Use (describe exactly, 1 -family Perc. Rate .................. <br /> .........i....... 3Q ?� <br /> Well ...1/.., home,garage, motel,etc.) Dr Well <br /> Subdivision Seepage Trench I <br /> aM�...i'........ <br /> Camping Unit Privy ....... ; <br /> ... .47[. .R................... .......... Seepage Bed i <br /> -------------------- -- <br /> N ilq <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Includellroad <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Ali nter- C' a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIS ING �. y <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i o� <br /> --------------------- ----------------------------------- <br /> 5. Lot Size: t i n <br /> Fig. A. 6. Location: <br /> , ly-7.y. ft. x.3R.6..Mll — a�.j.`l�:a?.s�l.r�.. sq.ft. �....... '3 <br /> rt- 89G.7o <br /> to"geN.. oiY/L`6 396. 70Co <br /> ( _ <br /> IN <br /> 0tt'''' <br /> >7�') [C-:-4T]4 <br /> y <br /> �\ o <br /> 1 � <br /> a <br /> � Q a '>15IT <br /> F <br /> m <br /> IT, <br /> r O <br /> W JJ <br /> z' k <br /> \> <br /> a <br /> D� IyE i! <br /> In 0 <br /> A C Nm c R <br /> M. fo a ca:10 Un <br /> m - m <br /> ON• m . <br /> Z O O pD n <br /> �06 . 7� i cin <br /> AAPo A/ 0/3-/F W <br /> 0 <br /> a <br /> �jo C <br /> Signature of Owner or ent Date ' <br /> /. <br /> Remarks ./N�.rJ.t�w..�..�!.r!.GSs( .a:S...y�t�bal.i?!�`�� ....��. �� Gtfil•LtRtrv�tr.,Cdd...., T x � O <br /> _ m <br /> .................................... .................................................................... .. .................... . .. <br /> ro O <br /> ... . . . . ... . .......-,............... h , mInspection Date �..-: ., ...... m <br /> Zoning Admini atort< / 88888 <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 thel Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />