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✓ G' -?c: (' »y � . <br /> Burnett County Office of Zoning Administrator u --I z <br /> 9 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c p� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Ngz�Ey........ ...... : - .... A1X,1..A 1�1v,.NF <br /> ............ . L. �Il.. a � 17oNNA n1Ee E <br /> ............................................ N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT C m <br /> .. ............!.`.!:...3......... .o..u......! ............................. <br /> ............................................................................................ADDRESS n <br /> ADDRESS <br /> .. .................(�. s:rf .e. .�........s.Y.�y3.. <br /> ADDRESS ADDRESS............................................................................ <br /> ..... ^. <br /> .. ................................................. ............................................................................................ <br /> PHONE PHONE <br /> NoN. ....................................................... . . . . . . . . . . ............A/ON E <br /> L <br /> PLUMBER WE LORI.LLER <br /> ........................................................................................... . . ...... . ............................................................................... <br /> ADDRESS ADDRESS <br /> . . . . .. . . . . ... ........ . .. .. <br /> G1 <br /> .......... E .... ................. ... ..... ....... ........ . . ..... .. ... ...... .............. <br /> PHONPHONE <br /> DESCRIPTION o 0 <br /> 4. Sanitary Facilities: o <br /> 1. Work: <br /> 2. New Building Details No. Bathrooms ....�.... <br /> 0 <br /> New BuildingNo. Bedrooms ..../.... z <br /> ...... . Type of No. � <br /> Addition •• ,,,• fnJ 0�;D Septic Tank Size Gals. .......... p <br /> Sanitary .......... Size .....I.0.... ft. x ... <br /> .u.?.Q,.......ft. .......... <br /> Filling/Grading „ ,,,,, Height............. Stories ...../......... 4a. Absorption Field Site: ` <br /> Moving .......... Area .......ao.�..:f!�` ............ Soil Type .................................... <br /> Q <br /> Mobile Home .......... Slope ......................................... .» <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ^`x <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> Subdivision _ {{��,,��� <br /> Seepage Trench <br /> .......... ... ..... . . . . ...............Ki`.`.yi.” f, <br /> Camping Unit ,,,..,,.., Privy t <br /> .... ..... <br /> ... . .............................. <br /> Seepage Bed <br /> ----------------------------------------------- E <br /> . A_ Include road <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_, should be sketched in Figc <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 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O <br /> o <br /> __-- <br /> ------------------ -----------9—__ <br /> 5. Lot Size: 1'Z?A Gc C�Y.�a/ -------------------------------- <br /> Fi A. 6. Location: w <br /> ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> � o a <br /> Cs <br /> _ W � <br /> V i o <br /> 0' <br /> N <br /> O A 7��4 ly//' �,V✓ w�( ill.""' � <br /> A <br /> / V <br /> N/�n (7'�•' 77 Vl r 9 to m Z <br /> 1 � A <br /> sa <br /> m N °- `c — W p W <br /> /0/ I -OO Lin < w ,a C. m <br /> m . <br /> m <br /> ...... a <br /> ---- <br /> Signature of Own r Agent /Date�S V �O p <br /> X <br /> Remarks m m <br /> ........................................................................................................................................................................................ �» <br /> � u <br /> ..........................................I...................... <br /> t? <br /> o :................................ <br /> Inspection Date ....................................... <br /> Ug N gm m <br /> o ' o o ' <br /> Zoning A nistrator 0 0 o ti <br /> NOTE: A preliminary site inspection must be mad?,J ,, pproval granted on all structures involving sanitary facilltwe <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />