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Burnett County Office of Zoning Administril for 1C f o <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3L� <br /> regulatio s of the State of Wiscon .n. <br /> Y..y..'...... ......................... .../ (Of Ari1 ...................................................... ...... <br /> OWNER (please rind CONTRACTOR or SURVEYOR or A ENT <br /> r ��. . <br /> <.. ... .r?z..Ye a.... Y................................... . . . `1 . �� 1 ..... 1 . . ..5. {t:y.. �,.s.... ...... <br /> lb <br /> ADDRESS DRESS i-�-- �- <br /> / / / � J •�} 7 't�l/I <br /> t... .Z''....................................... <br /> . .. <br /> ADDRESS <br /> �� q� Z,/l ��/t •//� _ ADDRE `/`, y_j 7 <br /> .� ✓... .zJ. .I..A..........!GJ,.`.J ../...:���-3............ .PHONE...II....... .../...!.�F........................................ ....... ilt <br /> PHONE <br /> .. . ...... ............................................................................... . . . ............................................................................. ....... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .................................................................................... ....... <br /> ADDRESS ADDRESS » C <br /> ........................................................................................... .................................................................................... ....... O »' <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathroom - <br /> 1. Work: 2. New BuildingDetails " """' o <br /> No. Bedro s <br /> New Building ,,,,,,,,,, Type of Construction: .. """' i <br /> Addition Septic nk Size Gals. .. ....... <br /> SanitarySize ............. . z ......... ft. .. ....... <br /> Filling/Grading ...... Height Stories ............... 4a. Absorption Field Site: <br /> .. ........ ....... <br /> Soil Type ................ i r <br /> Moving .......... ........................................... p <br /> MODIIs Home .......... <br /> Slope .................. .............. ....... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ..... .................... ....... <br /> Well .......... home,garage, motel,etc.) Dry Well .. ....... N <br /> Subdivision Seepa rench Z ' <br /> o <br /> .......... .................................................... <br /> Camping Unit .......... .................................................... Priv .. ....... <br /> Seepage Bed <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fi . A. : 0t ' C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed atQ ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <— <br /> S? <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t 0 <br /> ------------------------------------------- i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ........................................ . ......................... ........ :6� : ' <br /> l.oWe_r Udbb T-01-41 fA¢EA <br /> APP,Cy ysa� p ' D <br /> 0 <br /> _ _--.__—�__ __— /,/gyp r✓ <br /> P. <br /> - 1 <br /> P`�h <br /> /^�rn� y��p1 T rn <br /> r"�fC�A T� - F1RYQ IQ1 / i - "gym, mn� n w n a y <br /> be levo Cir► + tolled 5 3 z So : � Dm 3 <br /> o _.c m <br /> I r L�Yr sfr 0 is c <br /> ... �.. <br /> /.....4.......... Lv �'Br`y �clraR x � : O <br /> Signature of Ow Agent Date <br /> `emaZrkrs N... ..........................................( .... _ ............. ..... <br /> tOh uf <br /> /d ..... .. .............................. ..... <br /> .1. .....� . .................. p........�.........................' .. <br /> o <br /> o \ : <br /> v o . <br /> 0 <br /> e . N T <br /> .... NPN Pomo <br /> Zonin Administrator 8 g S 8 CA <br /> ninary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> case of sewerage disposal systems,a copy of the percolation test must be attached to this app ication before a permit will <br /> nurchase or install a septic tank,do any plumbing or start any building until a permit has bef n issued. A permit may be <br /> ntation of any of the information conveyed herewith is found to exist. Changes in plans Of specifications shall not be <br /> ,f the Zoning Administrator. <br /> .ER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND Ar PROVED. <br />