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J J <br /> Burnett County Office of Zoning Administratora o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <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 c <br /> Ordinance, /Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> EP <br /> ........................... ............. ...............................I.......................... <br /> OWNER Iplease print) CONTTRRAACCTOR or SURVEYOR or AGENT a <br /> ....... . . . <br /> ...5/�ep.:� w.!... ......ry......�..l...... 37 .................. <br /> ADDRESS ADDRESS <br /> Q.( .t/�c ......... ........ s <br /> ADDRESS ADDRESS <br /> ....... .y- aa� s .............................. . ..................OSY..-...'i4P................................ s Z <br /> PHONE PHONE . <br /> .......... <br /> PLUMBER WELLDRI LLER <br /> ' as <br /> ........................................................................................... AD' 'R'E'................................................................................ _ <br /> ADDRESS ADDRESS '� 0 <br /> as <br /> P..H...O..N..E.. ... . . . . .. ... . .. . .. ... . . . ... . . . .. .. .......... <br /> . .. .. <br /> oo. ... ... .. . ..... ... .... .............. ..... . ..... .... ....... P.H.O.NE... ..... ....... ..... ............. ..... ..... ...... . .... ........ <br /> DESCRIPTION Facilities: 0 <br /> . y <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> u <br /> New Building (,� Type of Construction: No. Bedrooms <br /> Addition .....,.... .............. ....... Septic Tank Size Gals. .......... <br /> -5 ll// 7i '� <br /> Sanitary „> Size ...LT4.T.. ft. x ... ........ ft. """"'• <br /> / i <br /> RulingtGrading ,,,,,,,,,, Height.... ... S ones ...../...... .. 4a. Absorption Field Site: <br /> Moving .......... Area .......?.. Soil Type .................................... <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... :9 <br /> Well ... home,garage, motel, etc.) Dry Well .......... ,� C <br /> Subdivision .......... — y /� Seepage Trench .......... eN <br /> ......�.......... ... .. ........¢/ <br /> Camping Unit .......... / .......... Privy .......... w <br /> ......................I............................. 1b7 J <br /> Seepage BedW <br /> ....... . <br /> --------------------------------- --- -------------------------------- r N .L <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig- A. Include road ri O <br /> setback, side and backyard dimension and location and setback from all bodies of water. If property Is located at a highway inter- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> n \ <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Usp' <br /> ------------------------------------------------------ <br /> 5. Lot ize: // Fig. A. 6. Location:// yy qq <br /> ...7. C?.... ft. x .l.a.U... ft. — .: ..�f....6G.�........ sq.ft. ..lCJ.0�7..fsO/..... ...:".�1..,�l...�. .�..:�J.�.. <br /> m <br /> N O <br /> o <br /> C) <br /> S� /XD� o <br /> d <br /> M <br /> 3O <br /> ,1 0ear C, <br /> a� vi c w <br /> Z 00 D a <br /> 13 <br /> fn <br /> m <br /> Signature of Owner or Agent ate o C <br /> s _ i.. .. .... ...... <br /> X . . . 37 <br /> Remarks .... .. ... .................................................................................................................................... <br /> ........................................................................................................................................................................................ _ <br /> � n <br /> ............................../............................................................................. .............................. <br /> Inspection Date ..1�.�..L.�..-.�.......... .�j 1!l '. .. . ........._ ....'1'U u N o o m <br /> Zoning Admin strator �`� 8 8 8 8 8 8 f/1 <br /> NOTE: A preliminary site inspection must tie 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />