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� L <br /> Burnett County Office of Zoning Administraor Ln g�g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 6 3• 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described notM <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ofind <br /> he <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws 3 `8 <br /> regulations the State of Wisscc^onsin. <br /> .............Il.�r• .C.1.4.......`...:........ .. ............. ...................................'11k ..................................... ..... m <br /> OWNER Please print) CONTRACTOR or SURVEYOR or AGENT <br /> ................/Ll..2... ..0............A..1...�j A1.1............................. ...................................................................................... ..... <br /> ADDRESS ADDRESS m � 1 <br /> .. . . ........WL.�STL„", ........Cl.SL.(..4�..fi............... <br /> ADDRESS % ADDRESS <br /> .-...7ra.. . . .—..:...7..6. .y......... ............................................................................... <br /> ....... ..... <br /> PHONE PHONE <br /> ........................................................................................... ."'''............................................................................... ...... <br /> PLUMBER WEELL DRILLER `^\ <br /> ........................................................................................... .ADD.. ... ..R....ES......................................................................... ...... 0 <br /> 1 <br /> ADDRESS S 'm ` <br /> n 0 O <br /> ........................................................................................... . ............................................................................ ...... - j N (� <br /> PHONE P..H..ON....E Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> ••' """ ` c <br /> New Building .......... Type of Construction: No. Bedrooms ... ...... `C <br /> AdditionSeptic Tank Size Gals. ... ...... <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> ... ...... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type ............................. ...... r i <br /> Mobile Home Slope ................................... ...... o <br /> r y .../ 3. Use (describe exact) 1 -famil Perc. Rate ............................ ...... <br /> y� y Dry Well <br /> ell ,,.,,,,,., home,garage, motel,etc.) Seepage Trench ... o <br /> Subdivision \ <br /> mpingU ..�.. .................................................... Privy <br /> Seepage Bed ... ..... <br /> Location of proposed structures and existing structures, well sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at .` <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. JJJJJJ Ut^ <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size- CcE '&t z x) Fig. A. 6. Location: �prJ -t77- <br /> .1-,.;7 <br /> Z <br /> /�..�. y?/GIA/S.o....!�a.✓1�0�...Q . l�d��.. ..fl.. <br /> CAMPING UNIT FOR 6 MONTHS o <br /> A <br /> FROM it s r TO /YU✓ �S <br /> A4 g�° :5,k 0 L 2 3f 0 <br /> f"JrH2 30, <br /> o . <br /> Tri;, <br /> 31 a vto r- DC W <br /> n w cr < > > n — �. m <br /> 4 m m a� m a a y <br /> O N O m 0 <br /> Z o > - 1 <br /> RI <br /> a on <br /> .. �... .. .... ..'..��. :.fs ....... : <br /> c_ <br /> A <br /> Signature of caner or Agent Date / n <br /> rn <br /> o : <br /> Remarks ... <br /> ...iki1.ylEdL.....:7'.(GAJG.G:,�....��...,,G,,!f�1.G�.......t:A./x1�....,�.01.�/l,ZI�P. .... <br /> m- <br /> �. : <br /> ...........,f' PaG,z.'....r..cic......O '/1r�G11�.....�'/�........... .... o <br /> Inspection DateK.. !..?�tl.tR41S... t�m�T # 1313 �... J... .... �1L44C?tC!(/� o N m <br /> (fit m <br /> 7/�gteo' I7 tie��l.����� Zoning Administ or ,�T✓� $ $ N <br /> 1 <br /> NOTE: A preliminary site inspection must be made and site appro al granted on all structures involving sanitary fac ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED. <br />