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.�'7'l <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <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 .0 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M C <br /> 0 <br /> . .557 <br /> .......... ...... .......................... ............................................................................................ n <br /> OWNER Iple e grin . CONTRACTOR or SURVEYOR or AGENT a <br /> . <br /> !C' <br /> fl.�'Q . ...... i'.. ....... .. ...................... ........ ............................................................................................ t, <br /> AD /.. . <br /> DRESS ADDRESS .* iG <br /> ......................g.�eb- 4. .. .... . <br /> �l <br /> . 7 .. . .. <br /> ADDRESS ADDRESS yv <br /> S <br /> PH LLrr PHONE <br /> PLUMBER + WELL DRILLER <br /> ........................................................................................... <br /> D 0............ <br /> ADDRESS ADRESS 1b ;� m o K <br /> n o iC <br /> .. �\ < <br /> ........................................................................................... : _. <br /> PHONE PHONE <br /> r <br /> DESCRIPTION 4, Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ,,,,,,,,,, Type of Construc n: No. Bedrooms .......... <br /> Addition --G,.,,x'l,S, t h�,s,,,,,,,,,,, Septic Tank Se Gals. ...r....... �p <br /> Sanitary <br /> .. 'i,.. Size .............. ft. x .............. ft. `l <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... ro <br /> Mobile Home .......... $OPe .......................................... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... O � <br /> Subdivision .......... Seepage Trench s:1 <br /> Camping Unit .......... ................................................ Privy .. ( <br /> . ... . .. .... .. ... .. . Seepage Bed �9.X3.b <br /> ---------------------------------------------------------------------- <br /> N <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be, sketched in Fig A- Include roadC <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property Is located at a highway inter- fw Aa <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 1` < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ...I...... ft. x ft. . ............................... sq. ft. ............................................................................... <br /> 'r <br /> N <br /> N O <br /> o S z i3 � <br /> � N <br /> ~ o <br /> o <br /> � T <br /> / 0 <br /> d <br /> €r <br /> -o vNi <br /> a; <br /> 0 6: m y a m <br /> 0 o n � 77 <br /> o <br /> vi - <br /> ............... ............................................. ..�.."c�.....`.�5....... � C <br /> Signature of Ow r or Agent Date <br /> X11. b : m <br /> Remarks .... . .. GCII"'P—f•� TI : . . . . . . m <br /> ........... . .. .................. ........................................................................................... <br /> y A'. <br /> Inspection Date ...(.`...J�. ~ffS : `� u P o 5 o Pm <br /> .......... .............. ... .... .......... ........ .................... ....................... <br /> Z Ing Administrator 80 00 0 8 8 8 N <br /> NOTE: A preliminary site inspection must be trade 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 tie issued. Do not purchase or Install a septic lank, 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 the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> J xt. <br />