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C�fi%`''��•' <br /> Burnett Coli ty Office of Zoning Administrator G o 0 <br /> '-r- APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE <br /> TO ADMINISTRATOR: The undersigned] hereby makes application for a Penult tar the work described and located as '< — oC <br /> Shown herein. The untlursigned agrees that all work shell but done in accordance with the requirements of the Burnett County Land Use2 : <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> . .r........_:. ... r.r_....._............................. .. W <br /> ......................................... ........................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR to,or AGENT 'n � <br /> 1.' ....9.L....._N......_Dgr._....�. s:� ..................................................._................_................ <br /> ls......_ d q € <br /> ADDRESS ADDRESS or <br /> : or <br /> .J?'7 9:.01..:..............5....5.��.3-.................................: .................................................................................................... <br /> ADDRESS ADDRESS` <br /> 7 <br /> ...............................r^t....................................................... ............................................................................................ :o <br /> ..✓. ... . .. ...... . ......... t..`.. .......................................... ...... ._........................................._.................._..._.............. <br /> PLER WELL DRILLER <br /> !N O <br /> ADDRESS................................................. .................. .ADDRESS_..........._.........................._..................._ .... JC <br /> p o i <br /> .....,._.............. <br /> 'PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: I ° o; °- ) <br /> No. Bathrooms " v <br /> 1. Work: p. New Building Details """"' `' <br /> n A <br /> New Building ._...._. Type of Corutr,I ion: No. Bedrooms ..a... 3' <br /> Addition .. ...-'�..'..)�GrS.!.....4...' ...... Septic Tank Size Gals. .......... �� <' _ <br /> .......... <br /> Sanitary �........... �J..e�q. <br /> . .. Size _._......... ft. z Stories <br /> ......... ft. y <br /> Filling ., Height............. Stories ........_..... 4a. Absorption Field Site: <br /> ........ <br /> ng ... Area ................................ ..... . Soil Type ............. ........................... ,: <br /> Grading Slope ..........- . . . . . <br /> I <br /> W <br /> Parc. Rare ............__._................ T : <br /> Mobile Home 3. Use (describe exactly �Tamil <br /> Privy -�....... home,garage,motel, etc.) Dry Well ........_ <br /> Well ........................_........... Seepage Trench .......... <br /> .......... <br /> Pr <br /> p <br /> rivy . ....... C -_: I <br /> Seepage Bed <br /> ________________----------------------------------------------------- <br /> Location <br /> __________________________________________________Location of proposed structures antl existing structures,well,sewage systems,roads.etc.,should W sketched in Pig. A. Include road G !iTf <br /> sptbeck, sitle and back yard dimension and location and serbnck train all bodies of wmer. If pop ur IV is located at a highw,,inter- ,)I <br /> section, show the irrteseeting highways and the setbacks required aided, it and at the intersection. CLEARLY LABEL EXISTING l <, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONSas <br /> 5. Lot Size: Fig. A. 6. Location: : ['+ <br /> ................ ft. x .............. ft . ............................... sq.ft, ...................... ..............._.._..._............... .............. <br /> 1 a t <br /> N O <br /> O J <br /> O <br /> 0 O <br /> D <br /> a <br /> D <br /> 1 T <br /> Z <br /> b <br /> ll n <br /> as �u+cd2 <br /> o car Ca <br /> z so o" <br /> o _ <br /> ch >> <br /> L <br /> of O ate <br /> Remarks _............................4. .e�i!r ...( `L� :-............... .............. ....:......................................................... <br /> , ^� E <br /> .a......... ......��`� OLCL � ..................,.n....In1J..._ _.`.... p OOfOO. , <br /> spect... ...'. _...._...._....• ......_.._... . .... ZoningkFf.�yrg ator....._._._.._..... i \oi <br /> Optics JI <br /> <. <br /> Inspection Date <br /> NOTE: A preliminary site mspaclion ntUst be made Ind site tq:prov:d granted on ill structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of fhe percolation test must be attached to <br /> this anti before a permit Will he issued. Do not purchase or install a septic tank, dirt hill plumbing mystfh any build <br /> ing until a permit has been issued. A permit may be revoked if misrepmsen udtion of any of the information conveyed here <br /> with is found w exist. Changes in plans m specifications shall not be made without approval of the Zoning Adm inisbatlin, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />