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4�nr C,"-7o <br /> Burnett County Office of Zoning Administrator M 13 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATORS The undersigned hereby makes application for a Permit for the work described and located as H � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> cz <br /> \� W <br /> ...J.Q.H441......� .R.Ido.Ff..................................... .P4FOAt,65..0 -44d A./&VAJ.�iY �✓ .j,...... V o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> �y........ t . r�v ".....lao G�1 �%....I m..r................................................. a <br /> ADDRESS ADDRESS <br /> ,y� Q <br /> ��P...a. �z.l.. f.N...4. ./.!.(t.✓....J�SpJ-1................ ........ ................................................................................... <br /> ADDRESS ADDRESS <br /> 4.1.a..-.. js.-..5a ......................................... .. . .�- . .ss....................................................... <br /> PHONEPHONE <br /> PLUMBER. ............................................................................... <br /> . . . . <br /> ELLDRI . . <br /> LLE..R.................................................................... U <br /> W <br /> ADDRESS ADDRESS o <br /> ........... <br /> ........................................................................................... .............................................................................. ... <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: No. Bathrooms .......... t <br /> 2. New Building Details o <br /> 9 <br /> New Building No. Bedrooms ' <br /> ,....,.,., Type of Construction: """"" <br /> Addition ..X..... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ....4......... ft. x .............. ft. .......... <br /> Fillingl Grading ........ Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving .......... Area ........................................... ° <br /> Slope <br /> Mobile Home .......... .......................................... rN <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... L i <br /> Well .......... home,garage, motel, etc.) Dry Well .......... cf i <br /> Subdivision Seepage Trench .......... i <br /> Camping Unit � '� Privy .......... <br /> P 9 .......... �..................... <br /> ....... . Seepage Bed .......... ,L i <br /> ------------------------------------------------------------ <br /> Location of proposed structures and existing structures well, sewage systems, roads,etc., should be sketched in Fig. A. Include road W <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 <br /> __—__ _----_— P i <br /> 5. Lot Size: Fig. A. 6. Locatipn: <br /> 14D.-.AOA.. ft. x .x0.j1..... ft. . ............................... sq.ft. ........./.©.7�f!.�.�.'!✓.. .'`.}�i.f�................................ <br /> LAKIF n <br /> N D <br /> �` 4CT � 5 NIS <br /> '10 - <br /> 0 <br /> 3� z Z <br /> � o <br /> d <br /> ° <br /> O Z <br /> t <br /> M r 9 N 2 <br /> m C N <br /> � m m <br /> i Z o o n 77 <br /> o <br /> Rogue o� <br /> y .4 <br /> Signature of.6wil ........................... ........ g5.......... o p <br /> Signature ofOwner o Agent De , r_ <br /> Remarks zCJ/ .�r+1. t!.7..... .T. N..$1.U. .... -f A/.J�E. ..... XIS � �Y....I�U.as..E.................. � x p <br /> m <br /> to <br /> ........................................................................................................................................................................................ o— <br /> i\ u <br /> ......................................................................................I.................. .. ..........:..... . . . . . . T <br /> U o: <br /> m <br /> ................. <br /> InspectionDate ....................................... r'i!'s...!:"'"..............9.................. .........�............. m <br /> Zonin Administr or i J 8 8 8 8 8 8 En <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 must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do dry 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 />