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at r 0 1, <br /> Burnett.County - � Office of Zoning Administrator p p <br /> l27APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �' 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work dexribed and located as r n <br /> shown herein. The undersigned agrees that all work shall before 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 <br /> r:�r. .N.r.C. ....... .oto. ........ ..... .................. ............................................................................................ <br /> OWNER 'pie...trinll.r' �$''y S'O / CONTRACTOP.or SURVEYOR or AGENT n <br /> gSTi#.r....._��.JJ ............. .. ................. ..........:...........................:....... q <br /> ADDRESS <br /> ADDRESS ADDRESS U j <br /> n, <br /> ........................................................................................... ................................................................................ ........... :. <br /> PRONE PHONE <br /> 'P, : l <br /> C.:.4� .'t'�a� %S� ✓............vv...i a . .. . ................. °d0� ' <br /> PLUMBER _ �y FrOI WELL DRI LLER I• <br /> ._.7.. .-3...SM(�!t...S..�.......S.z..Pn<Mt.Y:.w.y............... .............. ...._......._................_................._..._..,.............. <br /> ... 'h o <br /> ADDRESS ADDRESS 0 <br /> W o Y\ <br /> PIfO <br /> ........................................................................................... .......NE..................................................................................... N <br /> o -0 <br /> PHONE ' <br /> DESCRIPTION 4. Sanitary Facilities: ° = <br /> 0 <br /> 1. Work: y. Now Building Details No. Bathrooms <br /> New Building ...�... Type of Construction: No.Bedrooms. .....t1, .. <br /> Addition .......... . . ................. Septic Tank Size Gals. 2:S. <br /> Sanitary .. Size ft. x ..:a...... ft. .... im I <br /> Filling ..._..._ Height............. Stories ............... 4a. Absorption Field Site: i if` <br /> e . <br /> Moving ... Area ........................................... Soil TVPe .......__........ _............ <br /> Grading .... Slope <br /> r0 <br /> r <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate ....... ......................... <br /> Privy ....._... home,garage,motel, etc.) Dry Well .......— ny <br /> j <br /> Wolf Seepage Trench ....—... <br /> Subdivision .......... ..........._ ........................ <br /> Privy .. .... J <br /> cc <br /> ........................................---..... Seepage Bed t <br /> --------------------------------- <br /> Lucation of proposed structures and ii Godures well,sewage systems,roads,etc.,should be iketcbed in Fig:A. Include road 0' <br /> setback, side antl back yard din ansion and loaddh n and setback from all dome,of waterIforoporty is located at a highway inter- I U <br /> nmtion, <br /> no. IIIc in teencting highways and the setbacks required firm, them and m the intersection. CLEARLY LABEL EXISTING W <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I '�" p D \ <br /> —————————————————————————————————————————————————————————————————————— lev <br /> 5. Lot Size- Fig. A. 6. Location: IN <br /> .....(..?...... ft. x ...:.5....... ft. — ............................... sq.ft. ... .................................................... V .I <br /> L `y <br /> 7 � w <br /> N <br /> lr �` <br /> O 0 <br /> i <br /> o <br /> Z co <br /> Y T�1� I <br /> C ro <br /> rey <br /> o: <br /> m on, rnmZ <br /> m c <br /> vt < O1 5 o i <br /> If <br /> onup <br /> to <br /> 9 — - _ <br /> rn' <br /> g 20 r <br /> Signa> tune of Owner or Agent aD to W ;,1 <br /> Remarks .._c.&,?t..d.z�.../`... ...........C�Once.......4^!.._..Lu.f...... .. ...._._ .. ............._....._._... q 1)' ! <br /> ......... ....._n�.!:.._.�low.... .................Pi _6!K.e....19ve...._ es <br /> w <br /> . 1�................................................ �j <br /> ......................................... .............. .. X11 <br /> Inspection Date ... ............................. J J� Z.fing�r>�Is sinvolbint nil;ooto flit' o <br /> �..... <br /> Zonln Adml trator 000 <br /> NOTE: A prelint In are site inspection muss be mode 6 site ap oval Y ins <br /> b foe ri,rstrurtn)n can ll,giln, I a the e se if s ower d sposal sy,i s a copy of the.percriol on test m til I trached to <br /> ,h- m pphc1 f a He""[ will be is 1 Do of purchase ase o st' II a septic tank, doy f I tmb'tt.l o sta t a y puthl dl <br /> Pro nllale tlhasbe s el <br /> '. - Ap t may Ile -I 1's sc oat of of uty of the Ill for n' troll co eycdIii <br /> with is found to exist. Changes in plats or sped canons shtdl opt he o"tde w thout app'oval of the Zoning Adm n'strator- <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED GI <br />