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v <br /> Burnett County Office of Zoning Administrator iv 71 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 ,n M :� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use n '� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a prs <br /> ........................................... NA N � f <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT o. m <br /> !.........Qa.xllB..A ........................ ...... .................... ....................... ............... a '. <br /> ADDRESS ADDRESS <br /> �........Url Pv... ............................................................................................ <br /> ADDRESS ADDRESS <br /> 1 i e <br /> .....��.5:..�. .. J.�T...�.�.......................................... ....................... .................................................................... <br /> PHONE PHONE <br /> ^^ VoY1 <br /> .................��i�............................................................... .....�d:.,.T........vr..................................................... <br /> PLUMBER <br /> WELL DRILLER —{/ \ [ <br /> ........................................................................................... ..... '.` 11.: 1... ...........a5...7.M.3....................... O <br /> ADDRESS ADDRESS m t7 <br /> n o <br /> c <br /> . .......... ................. o <br /> ........................................................................................... ........................................................... .. . .. •» <br /> PHONE PHONE Z H 17 <br /> DESCRIPTION 4. Sanitary Facilities: ° o °» <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> 9 <br /> New Building „ ....,,., Type of Construction: No. Bedrooms .......... a <br /> Addition .......... , , ........ .. <br /> ... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ft. x .............. ft. """”" <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... <br /> Mobile Home Slope .......................................... .+ <br /> Privy ...X... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i E <br /> Well ....,,,,,, home,garage, motel, etc.) ....... <br /> SubdivisionSeepage Trench .......... ' <br /> Camping Unit .......... .................................................... Privy .. <br /> Seepage Bed .......... <br /> --------------------------------------------- :M <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road t <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o U <br /> --——————— <br /> � <br /> 5. Lot Size: Fig. A. 6. Location l' <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> st <br /> 8 �}cQts <br /> n <br /> N O <br /> O 7 <br /> n <br /> to <br /> �L' 7 8 F1GeQS ce JE C/oJE o °q <br /> 0 <br /> Seeifc-v /8 <br /> Z4 <br /> 38 /V fPHn.6t / 7 <br /> m _ L <br /> �fj�viBCS �C?cu.rSN�P <br /> Z <br /> 0 <br /> Nd9 :_ 0MZ <br /> or <br /> C -' f <br /> 9: <br /> (Il G <br /> Z o N D a m <br /> o I= n = � <br /> .. ........ . .....�(..'.. `5....... a <br /> C--,,re o ner or �� . <br /> gent 0 C <br /> �1d61.L ./1l11:.P�6CF�` vt�c i I x m <br /> Remarks� . ... „ <br /> _ . . . . . . <br /> u <br /> ............................................................................................................. . ..... ...... .. . . <br /> m.. . .............................................. <br /> Inspection Date ....................................... . . .... .. ' . . . FlP o P m <br /> x1147/ <br /> Zon ng Administrator $ $ 0 8 N <br /> NOTE: A preliminary site inspection must be made and site aRproval 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />