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Burnett County Office of Zoning Administrator 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 — Lnl <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m :� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 1,J/ . .. !� .........e�/,f v.45....................... ........nlA./�.T�?..1L4.w�?........kA9j............4...... <br /> 0 <br /> OWNER (please iiit) CONTRACTOR or SURVEYOR or AGENT a <br /> m <br /> Cao.u....X31..7...I3.......,S. .�ro.v '2...... �. ...........R ' 1........ rt. L �,� a <br /> ..... ........ . ...... <br /> ADDRESS ADDRESS <br /> m <br /> ..................................................... . <br /> Lyda Z............. ................C ...f...................5 ................................. <br /> ADDRESS ADDRESS <br /> x•35...-........ 9Y../p.................. ............... 5 .-...... ., ........................ <br /> PHONE PHONE <br /> ............ i2n.. !'L.lrk ! ........................................ ..... . . . .............................................................................. ;tel <br /> PLUMBER / WELL DRILLER <br /> ................ ....r..! 1..A.Itr.......................................... ............................................................................................ O <br /> ADDRESS ADDRESS <br /> ..............!/..4l........�4604 ..................................... ..... . . . ^. < <br /> . . . ................................................................................. Z o X <br /> PHONE PHONE J <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: g 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details � o ' )ti) <br /> New Building ........ Type of Construction: No. Bedrooms <br /> Addition ,. .. Septic Tank Size Gals. <br /> P: <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... a: <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> F� :U ; <br /> Grading .......... Slope .......................................... n ) <br /> Mobile Home Y Y Parc. Rate ................................... A <br /> ......... 3. Use (describe exact) 1 -famil <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... $ U I <br /> Well !� Seepage Trench .......... <br /> cyvLxus.. ..... :. r".�z�lr ^a i <br /> Subdivision .......... '.,L. . .....s.. .............. Privy .......... <br /> ��.�:G....wtM �-�^tSeepage Bed .......... 1C . <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road = © cr N <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter a 3 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ) N <br /> D o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> W o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: / OO Fig. A. 6. Location: �1 :� i <br /> [, ... ft. — 7 .... sq. ft. 4VAIT...4zQ.�..... <br /> v5$O <br /> �Qpo.1 M°o A, tD l S i <br /> N O <br /> xK <br /> o <br /> lisp <br /> 2. 0 <br /> 3g Q <br /> � cnry <br /> A N a a< n <br /> N <br /> o v < - <br /> ` : : < ' * m <br /> .2,31 O —D : - 3 <br /> fp J <br /> 111LLs <br /> ET �C <br /> ..... . ... ...:..... . .. . ...................................... J — <br /> Signature /Owner or Agent.. . ............. . ..........T- Date <br /> Remarks .... .......... .......�}..y..C....3..P........S.1Tiz.�.e.Tlr..c.e-....044...s : : v <br /> .Q............%3jR .J(......3.4.........0.44.......... ............... :!A3_ . . : : <br /> ...................................................................................................... .. ........... n.n................t...................................... <br /> OI Up <br /> : <br /> 17 <br /> O O Inspection Date ....................................... .....r.... . ... ......... oo <br /> M <br /> ez <br /> 0 �00 rnZoig this . <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 most 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 It misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />